SERVICES

Our satisfied, long-term clients count on Pacific Claims Management to provide them with a comprehensive suite of  services to help them operate at peak efficiency, performance and profitability. These include:

  • Claims Administration                       
  • Medical Bill Auditing & Alignment
  • Utilization Review                             
  • Financial Services Collaboration
  • Lien Management Services               
  • MMSEA Reporting
  • MPN Service Options                         
  • EDI Compliance

Premium Claims Administration & Strategies…

  • Custom tailored programs servicing public and private self-insured entities
  • Expertise in management of captive groups, JPA’s and guaranteed cost programs
  • Utilizing time tested and cutting edge best claims practices
  • Consistently effective processes anchored through communication, engagement, partners and results
  • Efficient claims handling resulting in cost savings
  • Setting a new standard for TPA performance

Managed care the way you want it: Flexible. Reliable. Affordable.

With PCM’s large selection of preferred, conflict-free vendors, you enjoy managed care with greater flexibility, enduring relationships and cost-effective performance.

Medical Bill Auditing & Alignment

  • Software integration
  • Contracted PPO network
  • Full reporting capabilities
  • Consistent with the most current regulations and fee schedules

Medical Provider Network

  • Established custom network
  • Multiple partner options for selection
  • Capability for placement in client-owned network

Utilization Review

  • Customized review plan & referral criteria
  • Web-based adjuster software approval system
  • Appropriate use of peer review
  • Client specific URO capabilities

Nurse Case Management

  • Outsourced service to select industry experts
  • Selective criteria for referral to nurse
  • Active monitoring for appropriate utilization of services throughout the claim