Laserfiche WebLink
ah are <br />yoer independent heahhcare choice. <br />When off-site care is required, NaphCare's utilization team collaborates daily with health services staff <br />and off-site providers to ensure appropriate usage of healthcare services. Always watchful, NaphCare is <br />poised to adjust to each day's demands. We review all cases prospectively; ER visits retrospectively; and <br />hospitalizations concurrently, ensuring the correct allocation of off-site services for our clients. <br />NaphCare's experienced Utilization Management nurses are trained to monitor off-site services allowing <br />them to determine the best possible outcome for patients, healthcare providers, and correctional <br />facilities. <br />NaphCare realizes that high quality 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 formula: match intensity of service with severity of illness. We consider the <br />following factors during the review process: <br />• Medical necessity using Milliman criteria <br />• Appropriateness and efficiency of medical services, procedures, and facilities on all requests <br />• Off-site service delivery— inpatient and outpatient setting <br />• Length of stay using Milliman criteria <br />• Maximization of on-site infirmary capabilities <br />• Care consistent with community standards, contractual, or legal mandates <br />• Coordination of on-site and off-site care — eliminates duplication of services <br />Off-site Requests <br />Information needed to determine approval or deferral of services is available within TechCorel , allowing <br />NaphCare's nurses to make reliable and informed decisions in a timely manner. The following <br />screenshot shows an off-site request in TechCareO. <br />n <br />� �Off. 777 ,° <br />Patient:- DOE, JANE • 02510761805067f29d89d:tang:l ids (1234) AGNiwnalkia <br />BOB: 4/811990 (Age=26) S : Female Race: PICNRE <br />i Housing: SSN: "HIDDEN•' NOT AYAIIABLE <br />Status: ACTIVE Booking Date: 4/8/2015 3:50:25 PM <br />Omen Type lwdz_ _. C+Aeercee <br />Inmate Medical Services <br />City of Santa Ana <br />Oninb Nod - <br />Inmate <br />d - <br />25F-74 <br />RFP No. 17-051 <br />75 <br />