Managed Care Services

Managed Care Services

Benefit Consultation & Design
Benefit Coordination with Third Party Administrators (TPA)
Preferred Provider Organization (PPO)
Utilization Review/Case Management
Statistical Reporting
Clinical Outcome Measurement
Quality Assurance Program

Benefit Consultation and Design
The Employee Assistance Network provides consultation to organizations in assessing the effectiveness of the current behavioral healthcare plan. Employee Assistance Network assists in the development of a flexible plan design that allows for easy access and ensures quality service delivery with built in barriers to cost overruns. Barriers against plan cost overruns are identified and implemented into the plan design. All recommendations will be consistent with organizational policies, insures quality service delivery consistent with community standards of practice, and comply with state and federal requirements.

Benefits Coordination with Third Party Administrators (TPA)
An Employee Assistance Network account manager will coordinate plan implementation with the organization's TPA. Coordination will clarify the process of authorization for services; establish plan protocols; address issues of claims adjudication and interpretation in order to ensure appropriate and timely claims payment.

Preferred Provider Organization (PPO) Network
The Employee Assistance Network maintains one of the largest PPO's in the southeast with skilled professionals representing a variety of clinical disciplines to provide services at a negotiated rate. Panel members must meet Employee Assistance Network's credentialing and privileging criteria. Panelist include individual practitioners, large clinical practices, agencies and inpatient treatment centers.

Utilization Review/Case Management
The Employee Assistance Network provides thorough management of behavioral healthcare benefits for access to inpatient or outpatient care. Management and services include pre-certification, authorization, concurrent review, and continuing case management. Clinical decisions regarding appropriate level and intensity of care are guided by the Employee Assistance Network's Level of Care Criteria with oversight by the Employee Assistance Network's Medical Director, a Board Certified Psychiatrist.

Statistical Reporting
The Employee Assistance Network's highly sophisticated computer system generates customized reports that enable a thorough analysis of plan utilization. Statistical data may be used to analyze cost, diagnostic information, average length of treatment, average cost by diagnosis, etc.

Clinical Outcome Measurement
Clinical outcome and life skill improvement is measured by client report and the administration of the BASIS 32, a nationally recognized computer driven outcomes measurement program. Client satisfaction and productivity improvement are also measured.

Quality Assurance Program
The Employee Assistance Network requires all clinical staff and affiliates to have a minimum of a Masters degree in a human services field and appropriate licensure by the state in which they work. Each counselor receives clinical supervision on a regular basis with oversight provided by Employee Assistance Network's Medical Director, a Board Certified Psychiatrist. There is also an ongoing internal case review process to ensure that each individual receives the most beneficial care possible.