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4W400r'� <br />year Wependwi healthcare 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 TechCare°, 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 TechCare®. <br />feat: DOE, JANE <br />DOB: 4/811990 (Agex26) <br />Status: AMVE <br />Re Type e <br />Inmate Medical Services <br />City of Santa Ana <br />k: 02510761a65067f29dagdSLangz)idG (i234) AdOffloWnfa. <br />Sine: Famale :Race: pICT41RE <br />SSW "HFDDEN"' NtlT AVAILABLE <br />ookfng Date: 4[812018 3:50:25 PM <br />mg� Pftt:VJD:M1n:A H FANtl .. <br />spwdy <br />Cart <br />Ow.da _ <br />?tld Bowios4 Gde <br />LCNiQM"J8 ' t peiilyVBNtlCtJazanlDefNne RtlaBM aIdTOM1dhbilC <br />1 <br />CPT9 _.. <br />MdoPTcpde - <br />i <br />,i <br />RFP No. 17-051 <br />75 <br />