Advanced Consumer-Directed Healthcare
Claims Processing and Plan Services
Front-End Processing
Medical Management Administration
Print and Fulfillment

Medical Management Administration

Offload the tedious and confrontational aspects of medical management to our experts

The cost of staffing utilization review (UR) nurses is high, but the cost of employing a chief medical officer and board-certified physicians can be too much for some plans and administrators. DST Health Solutions has the answer. We provide fully outsourced administrative services for medical management. URAC accredited and licensed to perform UR services in more than 40 states, our Chief Medical Officer, board-certified physicians, CPUR-certified nurses and IT professionals can become an extension of your medical organization.

With DST Health Solutions' proven medical management methodology, rapid implementation, consistent medical determinations and efficient turnaround of medical review decisions, you can minimize your overall investment in medical management and still obtain the information and capability you need to operate a prosperous, effective managed care enterprise. Medical management services offered by DST Health Solutions include:

• Precertification of inpatient/ancillary services
• Referral authorizations
• Concurrent care review
• Discharge planning/short-term case management
• Large case management
• Outpatient surgical/diagnostic review
• Appeals and reconsiderations
• Retro review of emergency department claims
• Case management
• Provider profiling
• Medical management reporting
• Medical services consulting

Outsourced medical management services deliver consistency and cost control

Using clinical criteria from InterQual, Millman & Robertson and other sources including custom criteria, our staff determines medical necessity and validates services requested by your healthcare providers and members. Through our experience in aggressively managing high utilization populations in multiple states, we have built best practices protocols - policies and procedures for consistently high-quality utilization review that we share across all clients. This consistency and objectivity allows for more uniform application of approvals for medical services.

DST Health Solutions' medical staff uses CareSTEPP, our flexible, proprietary medical management software application, within a framework customized to the client's requirements. To speed the claim payment process and to reduce errors, CareSTEPP has been integrated into our claims administration system for real-time access to authorizations, claims, membership and provider contract data.

For more on Medical Management Administration: inforequests@dsthealthsolutions.com.