Through its member PPOs, PPHN provides a full array of ultilization and medical management services to assure optimal healthcare resource use. These services are provided by certified Utilization Management (UM) organizations using NCQA and URAC compliant processes. As integral parts of each local community, our network providers are fully committed to assuring high quality and efficient use of healthcare resources to keep our communities healthy and economically viable.
SERVICES
- Pre-Notification and Pre-Certification of Services
- Inpatient Utilization & Concurrent Review
- Discharge Planning · Out-of Network Referral Management and Negotiations
- Case Management Services
- Centers of Excellence · Resource Management Reporting
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