Are you controlling your managed care costs?

What's in your contract? Give your program a quick review and find out if you need to take a closer look at:

• How are you paying for medical bill review? By percentage or by the preferred flat-rate method?
  
• Have you established criteria for your TPA to determine which cases go to utilization review? Sending every case may increase your costs unnecessarily.
  
• What are the triggers and costs you have defined for referral to managed care?
  
• Do you have a method of auditing you TPA to ensure your guidelines are being followed?
  
• Who is doing your medical case management? An independent company or a subsidiary of your claims administrator?