MISSION STATEMENT
Future Care is committed to providing superior quality managed health care programs that are responsive to our clients' needs and dedicated to their satisfaction.
By integrating people, technology, accepted medical standards and business systems, we are able to offer and service efficient programs that effectively contain client costs.
Common Managed Care Terms
PREFERRED PROVIDER ORGANIZATION (PPO)
A group of providers (hospitals, physicians,
specialists, etc.), also called "the network," who have a contract
to provide quality health care and to accept negotiated rates for their services.
UTILIZATION REVIEW/ MANAGEMENT (UR)
A term used to cover a variety of control
and review programs once a claimant or employee needs medical care in or out
of the hospital.
- Pre-Certification (Pre-Admission Review). A program for review of the appropriateness and/or length of stay. This process is initiated by the admitting doctor, patient, patient's family, employer, or adjustor by calling our toll-free number.
- Concurrent Review. The review of patient status during the service including appropriateness of setting and monitoring of non-related treatment.
- Discharge Planning. An element of the Concurrent Review process which ensures a timely hospital discharge to the proper setting.
- Retrospective Review. The review of the patient's care following services rendered.
- Outpatient Review. A program for the review of the appropriateness and duration of treatment for services provided in a non-acute setting.
PROVIDER RECRUITING
Process of negotiating fees and affirming provider credentials
to ensure network quality on behalf of the clients, third party administrators,
insurance carriers, or self-insured employers.
BILL SCREENING AND REPRICING
Step 1—Repricing. Bill is repriced to state fee
schedule, or Usual and Customary Fee (U & C). Often referred to as Bill
Review.
Step 2—Repricing. Bill is reduced to amount contracted with Preferred
Provider.
HOSPITAL BILL AUDIT
Review of bill to validate that services charged were
actually provided, and that services provided were related to the diagnosis
and/or injury.
CASE MANAGEMENT
The process of monitoring catastrophic, serious, and ongoing cases to minimize
unreasonable or unnecessary treatment, facilitate early recovery and coordinate
vocational retraining, when necessary.