Cost Containment

QHM cost-containment services address and apply to the entire medical event -
before, during and after:

Before the Medical Event

  • QHM trianglePre-certification and Admission Authorization
  • Network Identification and Negotiation
  • Cost Estimate of Care
  • Medical Second Opinions
  • Catastrophic Case Identification

During the Medical Event
  • Case Management
    • Assessment
    • Treatment Planning
    • Case Evaluation
  • Treatment Plan Evaluation (Oncology)
  • Interim claims review
After the Medical Event
  • Claims Review
  • Claims Revisions & Corrections
  • Claims Re-pricing
  • Claims Adjudication
  • Reinsurance Reporting