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# Preauthorization & Utilization Management Services
Healthcare plans require that a treatment or service is medically necessary to be covered under the plan. Preauthorization will establish medical necessity and, therefore, provide peace of mind about coverage in advance. This service protects both the member and the plan from unexpected surprises when the claim is processed. If you’re looking to have a knowledgeable second opinion in your corner, contact the ICM team today to inquire about our preauthorization services.
## Preauthorization and Utilization Management in Healthcare
The last thing any patient needs is to come out the other side of a medical service or procedure to find out that their healthcare claims are being denied by their health plan. Ensuring that every health service recommended to you is medically necessary is challenging, but it is vital to guarantee that you don’t face any unexpected costs. Our ICM preauthorization and utilization management processes aim to give you confidence that all procedures, hospital stays, and any other services are medically necessary and covered by your health plan.
The need for preauthorization differs depending on plan requirements. Circumstances such as surgery, hospitalization, ongoing therapy (speech, physical, or occupational), home medical equipment, chemotherapy, or radiation therapy may require preauthorization and we recommend that members or providers considering such services contact ICM to understand the preauthorization requirement(s), if any. **Our preauthorization and utilization management processes seek to give you confidence that procedures, hospital stays, and any other services are medically necessary and covered by your health plan.**
## The Benefits of ICM’s Preauthorization and Utilization Review
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### For Patients
* Peace of mind knowing that your surgery, treatment, or service is medically necessary and will be reimbursed by your healthcare plan.
* Assurance that the medical service is provided at a facility covered under the plan and is appropriate for the authorized care.
* Help with discharge planning after a hospital stay, such as getting durable medical equipment in place for recovery.
* Reduced utilization of unnecessary services, such as inappropriate or unnecessarily invasive procedures or exposure.
* Professional review of the services requested by your physician, providing a second opinion to ensure that every service is appropriate and necessary for your unique condition.
### For Clients
* Assurance that services are medically necessary and required for payment under your healthcare plan.
* Unbiased review of medical necessity.
* Other vendors providing medical management services may have conflicts of interest with the healthcare system they are being asked to monitor, but ICM is an independent third-party providing advice without bias.
* Assistance with direction to preferred or contracted providers, providing better payment terms.
* Early identification of high cost/complex patients, rather than discovering months later when the claim is submitted.
* Referral to other ICM programs for more specialized care and assistance.
  Timely reporting of activity to other healthcare plan vendors, which directly impacts healthcare costs.
## Why Choose Innovative Care Management?
At , we do healthcare differently. Our top priority has always been to give our patients and clients the best quality care at an affordable price because we believe every single member we work with deserves nothing less. Our compassionate care and non-adversarial approach are why we retain more than 97% of our client base every year.
If you’re looking for  for your health plan, you want to know you can trust your provider. ICM has been a reliable and independent organization for over 30 years now, doing our best to sincerely help each and every client.  To find out how we can be of service to you, reach out today to speak with an ICM team member.
## Learn More About Preauthorization and Utilization Management
We work with clients and patients across all 50 states, and our focus is on delivering a premium service with a compassionate approach.
**Call us today to learn more about our preauthorization and Utilization services.**
Call Now
Innovative Care Management, Inc.
PO BOX 22386
Portland, OR 97269
**Phone:**
Toll Free: 800-862-3338
Portland Area: 503-654-9447
Fax: 503-654-8570
Health
Utilization
Management
Expires 04/01/2027
### Notice To Plan Participants
Innovative Care Management (ICM) is your provider of medical management services and honors your rights and responsibilities as a plan participant. We value your privacy and will limit our communication with you to pertinent information about your health and your health plan. By providing your wireless phone number to either ICM or your health plan, you agree and acknowledge that ICM may send text messages to your wireless phone number for any purpose, including marketing purposes. At ICM, we prioritize diversity, equity, and inclusion among our consumers as a fundamental commitment to fostering a more inclusive and equitable world. Please see your health plan document for complete information on your benefits and eligibility as well as your rights and responsibilities. For more information, you may contact your health plan sponsor or benefits department as identified on your plan ID card. Some Utilization Management services may be provided in conjunction with our partner organizations.
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# Patient Care Coordination
Care Coordination, as delivered by our team at ICM, refers to a process that assures that our members find the right facility for their care, experience safe discharges, and enjoy proactive collaboration with medical resources. This fierce advocacy benefits the member and the plan (both clinically and financially). Unlike many large insurance companies, ICM focuses only on the members and Plans, not on contract kickbacks with providers or investors, which allows us to deliver a focused and customized solution. We conduct a tailored approach, much like our plans themselves.
## Your Trusted Patient Care Coordinator
At ICM, our nursing staff monitor the care patients receive in hospitals and work with the hospital to ensure a safe and effective discharge process. We may facilitate transfer to an appropriate level of care such as a skilled nursing facility or their home when the time is right. Our care coordination team supports obtaining additional medically necessary equipment, such as hospital beds, wheelchairs, or home oxygen. The care coordination can also coordinate and support other medically necessary services, including a home nurse or therapist.
Anybody with a complex medical condition that is covered under a health plan that contracts with ICM is suitable for care coordination support. We review each hospitalization through preauthorization and, if it will be of assistance, implement care coordination.
Once discharged from the hospital, ICM nurses may contact the patient or their caregivers to assist with education and support during recovery. Patients and their families are sometimes not well versed in advocating for additional services and understanding the benefits available. With a care coordination plan in place, an advocate guides you through the disjointed and often confusing healthcare system. This allows you the time and space to focus on healing.
## The Benefits of Having ICM as Your Health Care Coordinator
* Assistance in discharge planning, with a special focus on coordinating other providers to ensure a holistic approach to recovery.
* Clinical oversight of your discharge plan so you can utilize your available benefits to their full extent.
* Choice of preferred or contracted providers.
* Reduced likelihood of hospital readmission.
* Recovery in the comfort of your own home if that is clinically appropriate for your situation.
* Early notification of potentially high-cost patients so that you can budget accordingly.
* Better understanding of the potential expenses of the plan.
* Additional focus and support for the relatively small percentage of health care members/patients who spend the majority of the healthcare dollar.
* Trained, compassionate nurses are available to assist your health care members and their families in the face of a challenging medical condition.
* Patient steerage to network and contracted providers.
* Close working relationships with stop-loss carriers for the management of high-cost cases.
## Your Questions Answered
What is a Care Coordination?
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Care coordination is an umbrella term used to describe a patient’s care when and after leaving the hospital. It aids patient recovery by utilizing nurses to monitor their care, ensuring a safe and effective discharge from the hospital.
What sets ICM apart from its competition?
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ICM is 100% independent of outside ownership.  This independence allows us to focus on the health plan member and not shareholders, hospital system owners/partners, and investors.
Are there any limitations to group size for ICM services?
ICM offers services to groups of any size. Currently, ICM’s smallest clients are fewer than 25 employees, while its largest client is over 16,000 employees.
Does ICM work in all 50 states?
ICM currently has members in all 50 states.
Does ICM work with Reference Based Pricing (RBP) Programs?
Yes, ICM’s independence allows it to comfortably work in RBP type programs. Additionally, ICM is comfortable in member engagement programs incentivizing care delivery at facilities that deliver optimal outcomes at strongly discounted rates.
With failed discharges being costly to treat in addition to being disruptive to a patient’s recovery, ICM aims to reduce the likelihood of these events. Solid discharge plans prevent failed discharges and reduce hospital readmissions. ICM is dedicated to achieving the best for all of our patients and clients.
## Learn More About Care Coordination
**Call us today to learn more about our health care coordinator services.**
# Medical Case Management
Healthcare can be complicated and overwhelming, in particular when facing a challenging and daunting diagnosis.  In that moment, it is invaluable to have a fierce advocate in one’s corner.  ICM’s Case Managers are fully focused on supporting the member and their caregivers; this allows our highly experienced nurses to consistently alleviate the stress of this challenging chapter by providing people with the care and resources they need. To find out more about how ICM can help you, contact our team today.
## Case Management
Case management through ICM is structured to prioritize assisting those suffering from extreme medical conditions. Whether it’s a high-risk pregnancy, cancer, transplants, trauma, or any other life-changing situation, we aim to provide support and education to ease the challenge of this time. Having a nurse work directly with patients, caregivers, and providers to assist through these health complications is an invaluable source of support. A case manager is there to lend a supportive and kind ear, ready to help explain medical procedures and offer personalized advice throughout treatment, living with chronic conditions, and long-term medical management.
Claims for treatment and management of severe medical conditions are responsible for the majority of healthcare costs – claims for just 3-5% of members are responsible for up to 60% of the healthcare dollar. By focusing case management on this population, members can receive the best clinical care while benefiting from lower overall healthcare costs. We’re dedicated to ensuring patients and clients see solid returns on their investments - for every dollar spent on case management, health plans save an average of $4.54.
## The Benefits of ICM’s Case Management
* Opportunity to talk to compassionate and supportive nurses as needed.
* Access to educational materials.
* Help with understanding your medical condition and staying healthy throughout your treatment
* Assistance with understanding and navigating insurance.
* Support and guidance with claims issues.
Individuals shouldn’t have to navigate the healthcare system alone. ICM’s caring case managers can provide support, education, and resources to members as they face challenging medical situations.
## Learn More About Case Management by ICM
**Call us today to learn more about our case management services.**