TCN implements utilization management procedures, including pre-certification, discharge planning, concurrent clinical reviews and clinical case appeals, to evaluate the appropriateness and medical need of health care services and procedures according to evidence-based criteria and guidelines, and under the provisions of an applicable insurance policy.
TCN’s medical reviewers undergo in-depth UM training and proactively assess inpatient admissions, new clinical activities or ongoing provision of care, based on the analysis of each case.
Healthcare provider network management
TCN’s Medical Call Centre undertakes the referral of patients with an applicable health benefits plan to our extensive network of designated doctors and healthcare facilities. Selective contracting with these healthcare providers allows predefined standard of service with cost optimization and effectiveness.