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Med-Cert is committed to ensuring that the client/patient receives the best possible, most appropriate care while ensuring that health care costs are managed in the most efficient and effective manner.
Med-Cert provides its clients with Health Care Management, which encompasses intervention prior to, during, and after the event through such services as Disease Management, Utilization Review, Case Management, Transplant Network Access, and Retrospective Claims and Case Review. Each program is self-contained yet interactive, thus, providing comprehensive care management which focuses on the entire continuum of care and wellness/illness. Elements include client/patient education, advocacy, empowerment, and assisting clients/patients in making informed decisions. Med-Cert is staffed by fully trained and experienced professionals with both specialized and general expertise. Programs, though designed around nationally-accepted and approved protocols, are flexible to the needs of the client, whether self-funded or fully-insured.

 Utilization Management

Precertification and Continued Stay Review: The activities of Med-Cert's Utilization Management department include:
  • Inpatient and Outpatient Preadmission Review
  • Admission Review
  • Discharge Planning
  • Retrospective Review
  • Readmission Review
Med-Cert has developed written policies and procedures including specific formats typically completed throughout the review process. Timetables to be met, protocols for review, decision-making and appeal/reconsideration standards are always upheld during the review process. Licensed Registered Nurses and/or Physicians do all reviews and reconsiderations involving medical data. Reviews are performed telephonically and procedures in all cases comply with the requirements of the client's health insurance policy or benefit plan. Med-Cert provides a toll-free number accessible 24 hours per day. Normal hours of operation are from 8:00 a.m. to 5:30 p.m. Monday through Friday (except holidays). All incoming calls are either answered or routed to an answering service. A Med-Cert review nurse will respond to all messages within one business day. The Utilization Management department works closely with all other Med-Cert departments, the employer group, TPA and MGU to assure that the patient is receiving the highest quality, most appropriate, and most cost effective services possible.

Maternity Management: Our Healthy Beginnings maternity management program provides books, pamphlets and other information to expecting mothers.
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Health Information Nurse: Med-Cert offers a toll-free number to access a Health Information Nurse. This "Ask A Nurse" type program consists of general health and wellness topics provided telephonically to the plan participant.

Case Management Services

Large Case Management (LCM): Med-Cert's certified Case Managers are responsible for the management of catastrophic illness and injury cases. The goals are:
  • the assurance of quality of care,
  • the assurance of quality of life and
  • the promotion of the appropriate use of health care resources.
Implementation of LCM will assure quality of care, maximize recovery, minimize complications, and permit decision making by the payer and by the plan participant, optimize benefit allocation, minimize future claims, and decrease disability time.

Wellness and Disease Management (WDM): The goal of our WDM program is to better educate a person about their actual or potential disease state so that they may be empowered through knowledge to appropriately manage their own health, thereby decreasing over-utilization and increasing appropriate utilization of resources. The program is focused on education and empowerment through individual teaching of Proactive Health Management Skills by appropriate resources and through support to encourage compliance and use of learned skills.

Transplant Coordination: A special Transplant Registered Nurse Case Manager coordinates benefits, plan design, carrier programs, networks and preferred providers, care (before, during and after the transplant), appropriate use of pharmacy plans, negotiation of levels of care and fees, and community resources. Med-Cert works with the patient and family, Transplant Surgeons, Immunologists, Medical Directors, Transplant Coordinators, Facility Financial Counselors, Home Care Providers, etc. to improve care, cost, communication, and outcomes.

© 2017 Med-Cert, Inc. All rights reserved