Utilization management 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
Claims processing, auditing and adjustment Medical claims auditing is provided by TCN’s experienced in-house medical and administrative staff. Invoices issued by health providers are carefully reviewed for unnecessary or excessive services and procedures and relevant charges are promptly denied.
Pre-insurance assessment Pre-insurance medical screening of insurance policy applicants is pivotal in the underwriting process. Aspiring to offer a fast and efficient service, we liaise with a nationwide network of health care providers who promptly admit clients and provide professional diagnostic testing. Medical telephone interview The medical telephone interview optimizes the recording of a prospective client’s medical history, by use of a carefully structured questionnaire about past medical history and present health status and following appropriate questioning techniques. TCN’s medical telephone interview service is staffed by a team of experienced and well-trained physicians, whereas all interviews are recorded and can be maintained in the client’s file for future use.