Plan Services

The following is an overview of the range of plan services available throughout the Upper Peninsula Health Plan.

The Upper Peninsula Health Plan will, on a case by case basis, cooperate with insurance carriers for rental of its network of providers.  The array of services can include an ala carte of selections or an all-inclusive package.  A minimum selection must include provisions for delegated credentialing, as we do not rent the network if a renting plan is unwilling to delegate credentialing.

Our array of services includes:

  • 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 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 health 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 the health plan and the payer.

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

 


Page Last Updated: 09/30/2016