Precertification
Precertification is the process of confirming that a patient is eligible on a benefit plan to be covered by the payer and to collect information prior to the admission or service. This process should inform all parties in advance of treatment; identify patient for pre-service discharge planning and register patients for Case Management and Disease Management when needed.
Case Management
Case Management is a collaborative process of assessing, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes.
This service is provided for patients with potentially catastrophic illnesses, for example, high-risk pregnancies, or acute illnesses such as cancer. This service is also for patients with on-going diseases such as diabetes.
The case management process should inform all parties of insurance coverage and benefits, coordinate the services associated with discharge or return home, provide patient education, negotiate rates with providers who are out of network, and coordinate services with other healthcare providers.
SHARP currently provides case management services for the following health plans:
- Arkansas Glass Container Corporation
- Castino Industries
- NRECA—Craighead Electric Cooperative & Woodruff Electric Cooperative
- Qualchoice
- Smith Drug Company
- St. Bernards Behavioral Health
- St. Bernards Medical Center
