Navigator

Delivering Cost-Saving Solutions

Our Navigator program provides specialty services and solutions that help protect our clients from the financial losses associated with catastrophic medical expenses. To achieve this, we bring together resources designed to complement existing bill reviews and controls without taking over the management of a clinical case or disrupting the timely adjudication of a claim.

Catastrophic claims management often requires multi-disciplined methodology. Using a clinically based approach to financial management, we can implement Navigator services to assist in a wide array of situations. Our Navigator program supports the specific needs of each client – before and after a claim is presented for payment.

Core Navigator program offerings include:

  • Negotiation for single cases or out-of-area claims
  • Independent bill reviews for financial payment accuracy, medical necessity and treatment protocols
  • High-cost case review, including clinical necessity assessment
  • Review of specialty pharmacy dosing and supplies (evaluation of number of units, cost of units, etc.)
  • Introduction and evaluation of transplant networks
  • Services addressing fraud, waste and abuse

 

Discover more about our program, products and services in Managed Care Reinsurance: Guarding the Financial Health of Plans and Providers. (we will need to add the PDF of the brochure).