2023-112 - Medical Administration Services for Genesee County Self-Funded Health Plan

The Client’s goal is in developing a long-term strategy that incorporates plan management opportunities with access to the most appropriate and cost-effective provider networks.
 

• Provide a strategy incorporating network reimbursement/managed care capabilities into new or existing programs
• Deliver accurate, responsive, and timely claims payment
• Provide effective and accurate member services
• Provide timely, standard reporting and data file feeds to AssuredPartners and/or subcontracted vendors to assist the client in managing its Health Plan

• Select an administrator with a well-developed provider network to ensure employee access to high quality care through network physicians, hospitals, and providers
• Maintain effective pre-admission certification, concurrent review, and case management programs for all employees regardless of in or out-of-network access
• Maintain freedom of choice for the employees to those providers best able to offer both the quality care and utilization controls necessary to meet benefits cost objectives
• Maintain effective utilization management in all areas