A comprehensive and integrated program that monitors and evaluates quality (STAR, HEDIS, HCC, Pay for Performance), appropriateness, and outcome of care.
Trained professionals ensure consistent and quality care delivery. Please contact UM department for questions.
Provider Network Operations
Provider Services Department serves as a liaison between providers and the contracted health plans and ensures a complete comprehensive network.
Hospital Operations Department works closely with contracted hospitals to ensure quality and continuity of care for members.
Dedicated and trained staff, consisting of RNs and LVNs, are assigned to members with chronic conditions.
The claims operations department maintains timely routing and adjudication of all claims to comply with regulatory guidelines.