Medical Claims Management

Having a dedicated team of nurses means we provide highly trained staff to manage care for claimants and our clients can be assured of a superior quality of service in the medical case management they receive. Where required, our qualified nurses will act as named case managers, liaising with the patient and providing reassurance and advice throughout their treatment.

Healix case managers handle claims all the way through from the first call from a claimant to settlement of the final invoice.  They check that treatment is covered under the scheme rules, manage treatment and authorise bills for payment.

Bespoke approach to claims management

Our bespoke approach to claims management means we can accept direct referrals from client Occupational Health and dedicated Physiotherapists without a GP referral if required.  We have no restricted hospital networks or consultant restrictions. In summary, our case management team can:

  • Manage the claim from first appointment to discharge
  • Gain appropriate and relevant medical information relating to the claimant’s treatment so that their claim can be pre-authorised
  • Assist and advise on available treatments and care pathways
  • Make appointments and referrals as required
  • Discuss treatment plans with the treating medical and multi-disciplinary team and monitor all planned and delivered care to ensure that this remains reasonable and customary and in line with the claimant’s policy benefits
  • Where treatment is either not covered by the claimant’s policy or is no longer reasonable and customary, advise the claimant of any lack of benefit or cessation of cover at the earliest opportunity
  • Answer queries from the claimant and provide an explanation for treatment plans and drug therapies proposed
  • Organise / source a second opinion if required.

Healix Fees

We work on several different fee models which can be based on claims spend, number of lives or a percentage of the savings made on behalf of the client.

 

For more information, contact enquiries@healix.com