Our customers may access a broad range of value-added services through Summit ReSources. These services are designed to offer cost savings, primarily through appropriate care management that is focused on clinical outcomes. If you have any questions about our managed care services or would simply like to discuss them further, please contact Debbie Stubbs of our staff.

Portfolio Areas

Consultative Case Management

  • Help assess catastrophic cases

  • Provide information on rare or unusual clinical situations

  • Suggest alternative care options

  • Distribute information that may be useful to your medical management team

We offer these services at no charge to you.

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Case Management Seminar

Summit ReSources' managed care specialist is available to provide an energizing, half-day case management seminar for which attendees may receive 3.5 continuing education units through the Commission for Case Manager Certification.  The seminar is available to Summit Re clients at no cost.

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Transplant Management

National PPO Network

We have a preferred vendor relationship with GlobalCare, Inc.  for both "primary" network access and "out-of-network" cost containment solutions.

• GlobalCare offers access to over 100 PPO networks through the U.S., an international PPO, and a 24-hours-a-day/7-days-a-week Medical Help Desk, which assists members in locating the appropriate levels of care - anywhere in the world.
• GlobalCare's goals are to assist our clients' members in making informed medical decisions, provide the best cost-effective solutions and reduce overall medical costs.

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Negotiation Services

National Care Network (NCN) specializes in providing medical claims payers with comprehensive, measurable and technologically advanced medical cost management services.

• NCN's out-of-network fee negotiation solution uses a multi-tier cost management strategy.
• Data iSight is the company's new and innovative product that leverages nationally-recognized datasets and methodologies to create a peer-based comparative analysis
• Payers may select pricing methodologies consistent with their goals and objectives. 
• Data.iSight offers pricing transparency for payers, providers and patients through a web portal.

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Claim Recovery

Our claim recovery vendor, Health Decisions, Inc., is among the most comprehensive and sophisticated post-payment claim recovery services in the industry.  The focus for recoveries is in the following areas:

• Coordination of benefits
• Medicare responsibilities (ESRD, retirees, the disabled)
• Claim payment verification (duplicates, ineligible claimants, correct fees)
• Judicial judgments (divorce, subrogation)

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Medically Complex Newborns

The Assist Group is a care consulting firm that specializes in neonatal care management, forensic audit and claims negotiation services.

Since 1999, The Assist Group has helped to ease the strain of high-risk neonatal care through its CareAssist program.

• CareAssist believes that managing a neonatal case through collaborative, proactive care management results in positive outcomes for the family and significant cost containment for the health plan.
• CareAssist's physician-driven care management model focuses on improving the clinical and financial outcomes of high-risk babies
• The neonatal care management program has successfully reduced the length of stay by an average of 23%, with an average return on investment of 7:1.

The Assist group's ClinAssist forensic review applies medical and financial knowledge to establish fair and reasonable settlements of claims.

• ClinAssist's dedicated staff of professionals uniquely reconstructs the course of care to clinically validate the care path.
• A comprehensive analysis is performed to determine if the billing chronology mirrors the patient's clinical condition and if charges are consistent with medical billing standards.
• Charges are reviewed for errors, such as unbundling, and to identify unnecessary therapies and experimental drugs or procedures.
• Forensic review services have achieved an overall savings of 24% off of billed charges.

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Predictive Modeling

Ingenix is our preferred vendor for predictive modeling.  Ingenix is a recognized leader in providing innovative predictive modeling and information solutions to the healthcare industry.  Ingenix's products empower organizations to improve their performance at all levels.

• Organizations use Ingenix's Impact Pro software suite to measure performance, predict future medical costs and identify at-risk patients, enabling targeted, proactive medical management and financial initiatives.
• Impact Pro is the industry-leading predictive modeling and member identification software system that uses clinically meaningful methods to accurately measure and characterize future health risk for individuals and populations.
• Organizations use Impact Pro to improve clinical quality, member satisfaction and outcomes through effective medical management and financial applications.  Impact Pro is used by leading health plans and clinicians.

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Physician Consulting and Bill Audit

Advanced Medical Strategies (AMS) provides peer-to-peer collaborative physician interactions to improve quality of care and reduce healthcare claim costs.  AMS contracts with over 800 specialty physicians and assists clients through:

• Concurrent medical director services, which provide proactive medical case management by physician specialists to prevent costs from reaching catastrophic levels
• Physician consulting for patient-specific cases to provide independent opinions regarding the appropriateness of treatment and related issues
• Retrospective reviews of clinical chart documentation with medical necessity conclusions, detailed clinical summaries of hospital days reviewed, and detailed listings of denied or reduced charges as a function of medical necessity denials or alternate levels of care recommendations

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Pharmacy Benefit Management Services

Through our arrangement with Axia Strategies, our clients have access to unique programs that are designed to help them secure the most attractive and competitive PBM arrangements and to more effectively manage rising pharmacy costs.  Axia can help you determine:

• If your PBM's financial offerings are competitive and properly aligned with your organization's objectives
• If your PBM is delivering the discounts, rebates and savings based upon your current contractual arrangement
• If your benefit design and clinical initiatives are positioned to effectively manage today's rising pharmacy costs
• What else you can do to manage your overall prescription drug costs

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Supplemental Family Planning Product

Unified Life Insurance Company provides an independent, supplemental group insurance policy to selected client groups of Catholic-sponsored health plans.  The product and the Unified-health plan business arrangement have been specifically designed to provide an effective means to meet client demands and still remain compliant with the ethical directives of the Catholic Church and state insurance laws.

• The supplemental policy is issued directly to each insurance group.
• The scope of coverage can be packaged into any combination of family planning services at the group level.
• The health plan provides only limited involvement by assisting with set-up arrangements, providing monthly eligibility files and premium collection.

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