Asuris provides a wide range of case management programs and resources designed
to support our members at any stage of health. Care management programs are
either targeted to specific conditions or designed to improve or maintain overall
health. All care management programs are intended to supplement and reinforce
the care and guidance you provide to our members. Most feature clinical one-on-one
member support. Program availability may vary by group and benefit plan.
The following information and resources are offered to provide support to
physicians, other health care professionals and their staff:
| Learn more about |
Description
of information |
| Case
Management |
Our Case Managers are experienced registered nurses and
social workers will provide one-on-one support and guidance for any
disease or health condition. |
| Disease
Management |
Our Disease Management programs offer both early intervention
and long-term management of chronic conditions, such as diabetes, cardiac
and respiratory conditions. |
| Member
Programs |
We offer a variety of programs as enhancements to the
total benefit package provided to our members. These programs help our
members live healthier lives and reinforce and support treatment plans
with their provider. |
Practice
Guidelines |
We support the use of nationally recognized practice
guidelines to assist in determinations of the clinical appropriateness
of treatment services for medical and behavioral health. |
| Pre-authorization |
Pre-authorization is a prospective determination performed
by licensed health care professionals. The intent is to determine the
medical necessity and appropriateness of the proposed treatment, level
of care assessment and appropriate treatment setting.
| Not medically necessary
services and supplies |
| • |
Charges for services
and supplies determined to be not medically necessary by Asuris
are a participating provider write-off. |
| • |
The provider may only bill members
for such services or supplies if the appropriate written member
consent been obtained. |
| |
|
| Investigational services
and supplies |
| • |
Charges for investigational
services and supplies are denied as member responsibility for
services delivered on or after January 1, 2010. Asuris encourages
members to verify benefit coverage for proposed services. |
| • |
Written
member consent acknowledging financial responsibility is
not required for services deemed investigational. However, Asuris
encourages the provider to notify the member before these services
are rendered that the member may be financially responsible for
the charges. |
| • |
View services and supplies currently
considered investigational on the Asuris
Customized and Significant Clinical Edits list. |
|
| Pharmacy Prior
Authorization |
Pharmacy prior authorization information and forms are
located on the RegenceRx® Web site.
|
Quality
Program |
The Quality Program (QP) supports our commitment to ongoing
quality care for our members. We have developed standards and performance
goals and continue to monitor them to identify improvement opportunities. |
Radiology
QI/AIM |
Asuris’ Radiology Quality Initiative is
designed to promote the use of advanced diagnostic imaging services based
on widely accepted clinical judgment. We have partnered with American
Imaging Management (AIM®) to administer the program.
|
