NAPHCARE, INC. (2) - 2017 - Laserfiche WebLink

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<Awxer�e }roar Wopwdem hooiihcom ehoice. Inmate Tracking We use TechCare® to track all off -site requests throughout the Utilization Management process. On average, NaphCare's corporate Utilization Management nurses review off -site requests in less than one day, and when appropriate, approve requests. Requests referred to the physician are reviewed within one business day. The average time frame for approved service scheduling with community based providers is one day. Emergency cases are immediately referred off -site and are reviewed retrospectively. For continuity of care, the Health Services Administrator or designee submits a notification immediately. Upon return from an emergency room visit, including psychiatric visits, the appropriate Advanced Clinical Provider or designated staff will see the inmate, review the discharge information and treatment recommendations, and issue follow-up orders as clinically indicated. Documentation of ER visits is tracked and monitored via TechCare° to identify outliers and further ensure continuity of care. At NaphCare, our goal is to provide inmates with the care they need when they need it; care is not delayed within our Utilization Management process. In most cases, NaphCare completes the process —from the time of the initial request to the scheduling of the appointment —in less than two days. Utilization Management Key Interactive Components We control costs by performing the following types of review: 1. PROSPECTIVE REVIEW - Occurs prior to delivery of care and establishes medical necessity, ensuring appropriate and cost-effective care within the correct timeframe. The following services are reviewed for all requests: • Hospitalizations —scheduled inpatient and observation • Outpatient surgical or non -surgical Outcomes May Include ✓ Request for additional information for proper determination procedures ✓ Nurse or physician review • Specialty office visits and procedures ✓ Nurse or physician approval • Diagnostics, durable medical equipment and ✓ Alternate plan of care prosthetics • Course of outpatient treatment —physical therapy, dialysis, chemo, radiation NaphCare's site Medical Director, designated site staff, Chief Medical Officer or designee, and a dedicated utilization nurse review and discuss proposed non -emergent services to determine the most appropriate and medically sound approach to care. Resulting outcomes and planned courses of action are shared with the site Medical Director or designee and progress notes are documented in TechCare®. Prospective review can produce multiple outcomes, all of which are tracked by TechCare®. In our approach to correctional UR, we do not "deny" a provider's recommendation for off -site care, but rather, discuss the case physician -to -physician and develop alternate plans of care as appropriate. Our UR process takes less than 24 hours on routine cases when all necessary clinical information is provided. Requests for care within 14 days are reviewed and processed the same business day. Inmate Medical Services RFP No. 17-051 City of Santa Ana 76