HealthSmart Outsources First-Level Physician Reviews Using AllMed’s PeerPoint/MedCert Solution

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Benefits include lower costs, faster completion of medical necessity determinations, and better use of medical director’s high-value capabilities

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We have cut our review costs and optimized our medical director’s workload.

AllMed Healthcare Management, Inc. (AllMed) said today that the care management company, HealthSmart, has lowered costs and optimized medical director value by outsourcing its first-level physician reviews to AllMed and using the company’s MedCert service on its PeerPoint web portal.

HealthSmart had been using AllMed for specialty-matched pre-authorizations of complex procedures and retrospective reviews of claims and appeals. It turned to AllMed for first-level review help in order to better utilize the capabilities of its medical director and bring its medical review costs in line with budget targets. It is now using MedCert for more than 30 percent of first-level physician pre-authorizations.

“As a result,” says Anna Grant, HealthSmart vice president of clinical operations, “we have cut our review costs and optimized our medical director’s workload. Thus, he is able to devote an appropriate level of time to reviews while also focusing on other issues and initiatives that are of strategic significance to the organization.”

Grant said there were other first-level review choices available to HealthSmart, but AllMed offered a more efficient and cost-effective solution. PeerPoint web portal provides a simple, streamlined platform through which HealthSmart submits, receives and tracks the progress of cases.

AllMed’s certified, practicing physicians use MedCert to review each case, and produce a determination and supporting rationale. These are then returned via PeerPoint where they can be copied or electronically routed into HealthSmart’s medical management software. Reviews often can be completed in as little as 24 hours time.

“Partnering with AllMed has proven extremely beneficial,” HealthSmart’s Grant says. “With PeerPoint and MedCert, our reviews are completed more quickly than could be done internally, which means we’re able to continue to meet the guidelines and turnaround times mandated by the Texas Department of Insurance. Equally important, the AllMed solution has enabled our medical director to concentrate on high-value tasks that improve our business performance and ensure that we continue to deliver the highest level of care.”

About HealthSmart
HealthSmart Holdings, Inc., along with its healthcare-related subsidiaries, comprise an innovative healthcare solutions company serving nearly two million members and managing over $3.2 billion in claims. The company's headquarters is in Irving, Texas, and it currently maintains seven service operations around the country. The HealthSmart companies are dedicated to delivering integrated self-funded solutions by utilizing proprietary products and services, including benefit administration, provider networks, care management, prescription benefit management, primary clinic management, stop-loss solutions and innovative information system technology. The HealthSmart mission is to improve member health, reduce costs and deliver “smarter” healthcare solutions.

About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited independent review organization (IRO) serving leading hospital groups, ASCs, insurance payers, and medical management firms nationwide. More than 400 licensed and board-certified physicians in active practice conduct AllMed’s evidence-based peer reviews. The company’s PeerScore products meet or exceed The Joint Commission standards for OPPE and FPPE evaluations. More information about AllMed can be found on the company’s Web site at http://www.allmedmd.com.

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Brent Moszer

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