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