Comprehensive Care Coordination + Medical Management System
CareBASE aligns all managed care stakeholders
The HealthBASE Care Coordination Platform — CareBASE℠ — is a comprehensive Medical Management solution driven by e-Ordering with embedded decision support tools, customized rules sets, optional guidelines and an intelligent Provider and Network Management system. With CareBASE, the appropriate ordering, completion and cost of a referral for testing, treatment or supplies are closely managed on a single Platform by numerous inter-dependent parties and processes.
CareBASE easily aligns and links ordering physicians, claims adjusters and care managers, and automates tasks through a secure website so that all medical management and administrative workflows are synched with and instantly directed to the designated managed care systems, review agents, Networks/PPOs, and specialty and ancillary providers — helping optimize referral routing, care coordination performance and operating efficiency throughout entire episodes of patient care.
Results include instant transformation and elevation of non-preferred and low-performing managed care systems, faster and more effective patient throughput, reductions in program and stakeholder costs, improved Network/PPO penetration and realized savings, greater satisfaction and higher returns.
Features of CareBASE:
- Customized Referral management
- 2300+ clinical and benefit rules
- Embedded Decision Support/CDS functionality (optional)
- Procedure-based reminders
- Referral attachments
- Data mining, analytics, and reporting
- Seamless Provider and Network/PPO management
- Medical Management & Review queues
- Secure messaging and communications
CareBASE is a comprehensive Medical Management and Administrative Platform — with workflow solutions at every ‘event’ in the order + appointment process:
Comprehensive Care Coordination System
• Patient intake and set-up ⇒ to initial evaluation and diagnosis
• Ordering of appropriate medical tests and procedures using CDS ⇒ with links to medical review/UM/UR
• Pre-authorization determination ⇒ with approval status reporting
• Processing of approved referrals with attachments ⇒ using client rule sets
• Smart search, filtering & selection ⇒ with direction to optimal ‘in-Network’ providers
• Steerage to identified preferred provider Networks/PPOs, suppliers, vendors and cost containment programs
• Provider contact management ⇒ Appointment and patient services scheduling and confirmation
• Order/referral & Appointment status and discharge ⇒ with notifications to authorized stakeholders
• Medical reports and electronic health records (EHRs) ⇒ with image/media viewer, storage & retrieval
• Claims adjudication support ⇒ with ‘pre-auth’ status/code delivery
• Processing support of PPO claims and re-pricing ⇒ with reference to contract terms, negotiated rates and ‘pre-auth’ status
• Administrative reports + actionable analytics ⇒ ordering ‘appropriateness’, program compliance, profiling, trend/compare
