Managed Care

Accountability, No Conflict Of Interest

ASC works with our dedicated unit customers to build a third party administrator case management program with the vendors they want to use, or our customers may select to use the services of our partners. One of the advantages of a cost plus pricing structure is the ability to purchase managed care services at a much lower rate.

ASC has found that customers may want to use case management in different ways. We partner with first report triage programs like those offered by Medcor® or Company Nurse®. ASC can also assist customers with contracting dedicated nurses, and we can provide customers the cost benefit of contracting with the nurse directly.

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Partnering with case management companies which share our commitment to flexibility compliments the claim services, and partnership allows for any customer to have a robust claims operation functioning on-site in as little as 60 days. One of these managed care partners is CareWorks Managed Care Services (MCS), formerly MCMC.

CareWorks.pngCareWorks MCS provides the flexibility that ASC was looking for in a partner. CareWorks MCS has the ability to lease dedicated nurses which is an asset for improving communications and response time for our dedicated unit customers. This partnership improves savings, enhances claim decision making and allows ASC to concentrate on its core competency, claims service.

Third party administrator ASC in conjunction with managed care provider CareWorks MCS provides a comprehensive suite of managed care services.

Included Services

Technology

Zebra, CareWorks MCS' innovative claims management application, ensures that the ASC claim adjuster has critical information about each claim at his or her fingertips which allows the efficient management of the claim in a virtual transparent environment.

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Zebra Provides The Ability To:

  • Transparently view the real time status of each claim.
  • Research historical or in process claims.
  • Review, approve or deny in process claims.
  • Communicate directly with CareWorks MCS staff.
  • Transfer claims to other Zebra users.
  • Create combined bill documents.
  • Print claim summaries.
  • Visualize activity through a calendar view function.
  • Store all claim documents electronically in one location.
  • Increase efficiency through a notification system of important pending items.
  • Look up PPO information.

In addition, Zebra has a wide range of standard and custom reports. Standard reports are available in PDF format and Zebra also allows raw data to be sent to Microsoft Excel or Access for further evaluation and analysis. Reports can be sorted by ASC as well as by state of jurisdiction, provider and date.

Standard Reports Include:

  • Summary Savings Analysis – demonstrates savings, fees, return on investment and other relevant statistics.
  • Savings by State – demonstrates data by state of jurisdiction.
  • Claimant Detail – allows statistical analysis of individual claimant activity.
  • Provider Summary – allows evaluation of provider usage and treatment trends.
  • PPO Penetration – demonstrates PPO effectiveness.
  • Non-network Provider Summary – allows evaluation of non-network providers.
  • Security - online, real-time access to case status

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"I highly recommend ASC and its employees - they have been a great asset to our organization, and we have enjoyed working with them these last five years and look forward to many more." Gwinnett County, GA HR