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Healthcare utilization management is a process for evaluating medical care efficiency. The case manager identifies appropriate levels of care and considers alternative therapies and resource usage. To measure improvement in medical care efficiency, the practitioner presents care providers with specific opportunities to improve and monitors their progress over time. Heartland Care Management Services, Inc.’s (hereafter referred to as Heartland) utilization review program is currently fully staffed and operational. Heartland’s home office, located at 88 Commerce Blvd, Benton KY oversees all aspects of the utilization review program for KY and TN.
The patient, facility, or attending physician/ provider will notify Heartland’s reviewer to provide information on the circumstances and conditions that may require admission to or continued stay in a health care facility. Heartland recognizes some individuals may have special circumstances that require additional flexibility in the application of screening criteria. These special circumstances may include, but are not limited to a person who has a disability, acute condition, or a life-threatening illness. Our reviewer will obtain only the necessary medical information needed to make a considered and informed decision regarding the recommended services and in a timely fashion. This will be accomplished by whatever media necessary, i.e. phone contact, email contact, and/or written correspondence.
Our HIPAA compliant environment ensures security and privacy. Heartland Care Management, INC has implemented strategies in adherence to HIPAA. We follow strict quality assurance protocols to consistently exceed client expectations. Our goal is to protect the privacy and security of individually identifiable health information and our clients’ ability to use our services. Heartland Care Management, INC remains confident that the effort put forth will produce the results necessary to achieve our compliance goals.