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D. OFF -SITE REFERRALS TO PREFERRED PROVIDERS <br />1. NaphCare will determine the medical necessityofall calf - site medical services and abtamapproval <br />from the responsible contract agency. <br />UTILIZATION MANAGEMENT <br />NaphCare takes correctional utilization Management to a <br />new level try reviewing all aff -site services, When off -site care <br />Is required, NaphCare°s utilization team collaborates daily <br />with health services staff and off -site providers to ensure: <br />appropriate usage of healthcare services. Always watchful, <br />NaphCare Is poised to adjust to each clay's demands. We <br />review all cases prospectively; ER visits retrospectively; and <br />hospitallzationseancurrently, ensuring the correct allocation <br />ofoff -site services for our clients NaptiCare's experienced <br />Utilization Management nurses are trained to monitor off -site <br />services allowing them to determine the hest possible <br />outcome for patients, healthcare providers, and correctional <br />facilities. <br />Utilization Management <br />Philosophy <br />✓ Supportive team approach <br />✓ Optimum customer service <br />through professional and <br />accurate communication <br />V Decisions based on clinical <br />knowledge, expertise, criteria <br />guidelines <br />NaphCare realizes that high duality care does not have to be expensive; expensive care does not <br />guarantee high quality; and preventive care saves money long-term. Our Utilization Management <br />program follows a simple formule; match intensity of service with severity of Illness, We consider the <br />following factors during the review process: <br />• Medical necessity using Miffirnon criteria <br />• Appropriateness and efflclencyo €medical services, procedures, and facilities on all requests <br />• off -site service delivery -- inpatient and outpatient setting <br />• Length of stay using Mhfi'mancriteria <br />• Maximization of on -site infirmary capabilities <br />• Care consistent with community standards, contractual, or legal mandates <br />• Coordination ofon-siteandiaffsitecare — eliminates duplication of services <br />LIM and Off.-slte Requests <br />information needed to determine approval or deferral of services is available within TechCore' <br />allowing NaphCare's nurses to make reliable and informed decisions in a timely manner. The following <br />screenshat shows an off -site request in TechCare" ". <br />Inmate INedical SGr-v ces RFP No. 1,"34 <br />City of Santa Jana 68 <br />25H -72 <br />