Medical Management

Prenotification of Hospital Admissions

Admission precertification is no longer required for routine hospital admissions, which includes hospitalization, surgery and diagnostic testing performed at in-network facilities. However, if services are performed at an out-of-network facility or outside of Arkansas, it is your responsibility to notify the utilization management company by calling the pre-certification number on your ID card.  URAC

Case Management

Case management is a personalized, multidisciplinary process that aims to:

  • Identify high-risk or high-cost patients;
  • Assess treatment options and opportunities to coordinate care;
  • Design treatment programs with the medical team to improve quality and efficacy of care;
  • Maximize the member's insurance benefits;
  • Manage patient needs in the appropriate setting to ensure the optimum outcome.

The focal point of case management in all of its roles is to empower patients, giving them and their families access to a greater understanding of their disability or disease, a larger voice in the delivery of their care, and more personalized attention to their needs. Case managers enable patients and their families to make informed decisions and help patients deal with the complexities of the health-care system.

More Information on Case Management: Program description and case-manager locator.

Special Delivery

Special Delivery is a program that provides education and support services regarding health-plan benefits to expectant mothers with normal or high-risk pregnancies. This program has been designed with input from top obstetricians to educate pregnant women regarding their risk factors. As an enrollee in the program, benefits covered by the health plan include:

  • Educational materials including two reference books, What to Expect When You're Expecting and Taking Care of Your Child;
  • Customized educational material specific to the individual's health status and needs;
  • Risk assessment as early into pregnancy as possible, then again at 24 weeks;
  • Access to an obstetric nurse and pediatric nurse, who can answer questions or concerns;
  • Coverage of specialized services if they become necessary.

More Information on Special Delivery: Program description, resource list and enrollment information.