• Credentialing services for all network participants in accordance with industry credentialing standards.
• Policy, procedure, and protocol development
• Quality Assurance and Quality Improvement programs to include a full array of onsite and remote verification assessment and review of provider services.
• Utilization Management, including pre-admission certification, prior authorization, prospective, concurrent and retrospective utilization review and referral management, case management, disease management programs, clinical practice guidelines and Clinical Advisory Committee Review and design functions and encounter data review.
• High degree of data interface capabilities through LAN and WAN networks for electronic billing, communications, authorization and other care interfaces.
• Access to a turn key provider network including over 400 physicians, 40 physician extenders (NP, PA, etc.), 14 of the 15 Upper Peninsula Hospitals and a wide array of ancillary services and programs.
• Medical Director

Network and services access may be obtained through a variety of funding schemes.  The Plan and its provider network will consider straight network rental with services, capitation, shared risk arrangements, discounted fee for service, withhold with reconciliation or other funding arrangements with mutual incentives for both Plan and payer.

For more detailed information on safety, quality assurance and quality improvement programs, or utilization management programs contact Clinical Services 1-800-835-2556. Annual evaluations of these programs are available upon request from Clinical Services.