What We Offer
24/7 toll-free call center staffed by licensed clinicians
- Professional triage and referral services around-the-clock to assist employees and their families find the most appropriate provider at the level of care that meets their needs
- Tracking of all emergency calls to ensure the services are available
- Immediate access to assessment services for emergent needs
- Immediate problem resolution, enhancing customer satisfaction
Comprehensive regional network and National Affiliates
Claims Processing
- Full range of services, including claims processing, adjudication and provider payment
- Calculates monthly cost data for medical loss reporting
- Monthly reports on utilization by types of services
- Claims lag reports by month/year
- Customized reports upon request
Quality Management Program
Some of the standards being surveyed include:
- Timely investigation of complaints, grievances and denials
- Annual reports on both provider and member satisfaction
- Ongoing review of "level of care" decisions rendered by the Quest utilization management staff
- Continual monitoring of the application of admission and discharge medical necessity decisions
- Ongoing audits of clinical treatment records and provider sites
- Initiation and maintenance of clinical studies to demonstrate improvement in areas such as treatment of children with Attention Deficit Hyperactivity Disorder and other psychological disorders
- Monitoring the coordination of mental health and substance abuse treatment with medical services such as primary care physicians
