Precertification and Case Management

Disease Management
  - Diabetic Disease
Management
  - Respiratory Disease Management

QCP Rx - Pharmacy Benefit Management

HealthPhone

NIH Newsletter

Pre-certification

Many plans require pre-certification of various services. It is important to be familiar with these requirements before receiving treatment. Please refer to your plan document for the listing of services that require pre-certification.

Common pre-certification requirements are:

• inpatient hospital stays
• surgeries and outpatient invasive tests such as cardiac catherization, etc.
• home services
• emergency room visits
• outpatient therapies
• durable medical equipment

It is important to note that these are just examples. Pre-certification requirements vary greatly between employers and health plans. If you are uncertain as to whether or not a service requires pre-certification, contact your plan administrator at the customer service number on your ID card or your human resources department.

Case Management

Case Management is a voluntary program designed to help patients and their families that have encountered a serious or catastrophic illness. Through patient education, advocacy and communication, the QCP staff will help you through the healthcare maze. Patients with serious healthcare conditions are assigned a case manager to be their personal advocate. Our case managers assist patients by providing guidance and information regarding their condition, services they may need and available resources and by coordinating the more appropriate care setting and/or services in collaboration with the attending physician. Many patients see their case manager as a key resource for information and comfort during difficult times.