You make your patients' lives better. We'll do the same for you.
Our precertification, referrals, claims and payment processes are streamlined to help you focus on what you do best — caring for your patients.
We support you with:
- A coordinated approach to care with innovative patient outreach/education
- Disease and case management resources
- Patient centered medical home transformation
- Online self-service tools and live-agent support
- Local Provider Relations staff committed to your success
We understand the demands programs like Medicaid and Medicare can create for your staff. Our team of local and national professionals is here to help.
Our National Contact Center offers:
Your local Provider Relations representative can help you with:
- A dedicated provider line for when you can’t access the Internet
- Live agents to assist you
- A 24/7 Nurse HelpLine to help members get after-hours care
- Provider orientation
- Health education material for your patients
- Strategies for growing your practice
- Tips to ease administrative burden for your staff
Our care managers are trained to help you meet the unique needs of Medicaid or Medicare recipients. We account for behavioral, physical and social factors when developing each individual member’s plan of care. Our member-centric care model features early identification of needs, continuous assessment of health and a patient centered medical home approach that promotes collaboration among members, family, service coordinators, providers and community resources.
Our Disease Management Centralized Care Unit (DMCCU) provides a holistic care management approach that allows you to partner with our care managers to focus on the special needs of members living with chronic diseases. We offer 13 Disease Management (DM) programs, eight of which are accredited by the NCQA:
**Programs offered may vary by market
- Bipolar disorder
- Coronary Artery Disease (CAD)*
- Congestive Heart Failure (CHF) *
- Chronic Obstructive Pulmonary Disease (COPD)*
- Major depressive disorder *
- Substance use disorder**
Health Education and Wellness
We advocate a community approach to health education and outreach. We build on our relationships with community- and faith-based organizations, advocacy groups and other community resources to host health fairs, community events, and no-cost health screenings and develop health initiatives specific to the needs of our members. Through education and outreach, we work with our community partners to promote healthy behaviors, preventive care and wellness.
Our Innovations and Real Stories®
Watch our Real Stories® to see how our team of providers, social workers, care coordinators and partners make a difference in the lives of those we serve — all while saving states’ and taxpayers’ money.