Services for Payers

BHM Healthcare Solutions partner with the largest national and regional payers in the industry. They look to BHM for many benefits, like increasing access to behavioral health expertise, smoothing erratic workforce needs, and trusting in our delegation services. Choosing BHM:

  • Saves Money. We Do More For Less.
  • Ensures Meeting Turnaround Times. We Have The Right People, Processes, and Programs.
  • Leverages Subject Matter Experts for Complex Cases. We are Connected To Reviewers You Need.
  • Streamlines Your NCQA Renewal Process. BHM is NCQA/UM Accredited.

Payers wanting new levels of efficiency, like you, see us as key to raising their day-to-day operations.

Survey Results Define CMO Responsibilities

Peer Review Services

Since 2002, we supplement your utilization management process by­­­ providing medical director administrative expertise.

Our network of peer reviewers assess clinical information/documentation received in the provider service request, and, on a case-by-case basis, decide if the health care services requested from the providers are appropriate and should be paid.

We do this accurately, transparently, and in a very cost-effective ways.

Build Your Peace of Mind
BHM meets industry quality standards. NCQA-Accredited programs are eligible for automatic credit when they work with another NCQA-Accredited organizations.

Validating completeness of every request and synthesizing clinical notes BEFORE reviewer assignment means reviews based on accurate and complete records.

Our special approach delivers an average 85% connection rate. Reviewers speaking with providers allows providers the opportunity to fill in the details, nuances, and thinking behind their notes; lead to improved provider relations.

You remain in compliance with your accreditation standards and regulatory requirements.

Clients use trend reports for identifying patterns, including red alerts and potential problem identification, to help uncover potential improvement and training opportunities for their team.

Imagine your complex cases processed as easily and as accurately as your most typical requests.

That’s the BHM difference.

Peer-to-Peer Outreach Services

Industry connection rates for Peer-to-peer conversations run about 50%. Our special approach delivers an average 85% connection rate, because an Outreach Coordinator is assigned to every call request and delivers a personal touch.

Contact the case doctor setting up a meeting time

  • Lowers time-wasting phone tag
  • More efficient use of everyone’s time

Coordinate the scheduled call with provider and reviewer

  • Focuses on being on-time

Record and summarize the call

  • Act as independent note-taker and observer
  • Send call summaries making sure doctors were in-sync

Delegation and Delegated Entity

Delegation is a formal process by which an organization gives another entity the authority to perform certain functions on its behalf. A delegated entity receives the authority to act on an organization’s behalf, but the organization remains accountable.

If you can believe it, some payers double pay for determination requests. First, they want a third-party review, then the reviewed determination is RE-reviewed once in-house. BHM offers delegation as a cost/time saving option.

Medical Director Oversight

Mergers, reorganizations, and turnover create unique combinations of staff resources striving to meet the ever-changing work load of claims processing.

We meet your Medical Director staffing needs through a menu of administrative service options.