196 Charmant Drive,
Suite 3
Ridgeland, MS 39157
Phone: 1(601) 366-3669
Toll-free: 1(800) 748-8773
Pre-Certification - On-line Precert Software Access
Hughes & Associates' pre-certification program is designed to monitor and evaluate the course of treatment rendered by all health personnel given a standard of desirable care. It is a process that looks at the following to determine if the treatment, as prescribed, is appropriate:
- The medical necessity of treatment
- The setting for the treatment
- The types and intensity of resources to be used in the treatment
- The time frame and duration of the treatment
The purpose of Hughes & Associates' pre-certification program is to monitor the delivery of medical services to insure that those services are performed at the appropriate level of care in a timely, effective, and cost-efficient manner.
- PRE-CERTIFICATION
- Pre-admission Certification
- Continued Length of Stay
- Discharge Planning
- Retrospective Review
- Outpatient Surgery
- Diagnostic Tests
- Physical Therapy Review
- Mental Health and Substance Abuse
- High Risk Maternity and Neo-Natal
- Home Care Services and DME
- Notification of Long-Term and High Dollar Treatments
- Cost Savings and Utilization Tracking Reports
The above services can be selected individually, separately grouped or bundled as a complete managed care cost-containment program.
PRE-CERTIFICATION FLOWCHART
*By utilizing nationally accepted criteria and objective clinical experience, each case is analyzed for: 1. medical necessity of admission; 2. appropriate length of stay; 3. alternate treatment or setting; 4. discharge plan. **Cases requiring further review are referred to one of our staff Mds.