Working closely with you to design and build effective cost containment solutions, HCE will customize a review program to suit your needs, using some or all of the following services:

• Hospital Review. Preadmission and concurrent review of acute hospitalizations, as well as the direction of patients to contracted providers, when applicable.

• Outpatient Services Review. Pre-service reviews of all outpatient surgical procedures and certain high-dollar diagnostic services and the direction of patients to contracted providers, when applicable.

• Case Management. Working with the provider, patient and patient's family, a personalized treatment plan is developed that provides the medically necessary care in the most cost efficient manner.

• Ancillary Services Review. Prior authorization of physical, occupational and speech therapy, as well as chiropractic and acupuncture services, designed to reduce costs by preventing over-utilization.

• Dental Claims Review. Review of selected dental treatment plans and claims by HCE's dental consultants are conducted to determine appropriateness and dental necessity.

• Independent Medical Review. Evaluation of selected medical cases and claims for: reconsideration of services previously denied by the claims administrator or primary utilization management company; determination of usual and customary fees prevailing in a geographic region; new and/or unusual medical procedures; value determination of "by report" procedures; experimental and cosmetic procedures; coding abuses and fragmented billing.

• Early Start Program. A screening program designed to identify high-risk maternity cases. Close monitoring and education increase the chances for a healthy pregnancy.

• L.I.F.E. Lifestyle Improvement for Families and Employees program offers utilization management for mental health and chemical dependency care in the least restrictive setting.

For more information, contact HCE at 800.333.3018, ext. 316 or 332.