Medical Management and Cost Containment

Simplan provides clients and members with only the finest medical management and cost containment programs in today’s industry.  Our goal is to help customers maximize savings on current claims through utilization and case management and minimize tomorrow’s risk through maternity management, disease management and health and wellness.  Simplan provides a proactive approach to improving health while reducing health care costs for the long term.

Simplan provides the following Medical Management programs to its clients:

  • Disease Management
  • Utilization Review
  • Case Management
  • Maternity Management
  • Oncology/Cancer Management
  • Dialysis Program
  • Transplant Program
  • Diabetic Program
  • Mental/Substance EAP
  • Specialty Networks
  • Health and Wellness
  • Patient Advocacy
  • Nurse Line and Physician Line
  • Online Health Tools
  • Biometric Based Wellness
  • Health Risk Assessments

Cost Containment

  • Review claims from $1.00 up
  • Fraud and abuse technology
  • Optimization of in and out-of-network claims savings
  • Sophisticated claim edit technology
  • Direct access to experienced examiners
  • Average turnaround time of five-to-eight days
  • Subrogation services feature full-time legal expertise and monthly claim transfers
  • Variable claim authority levels with client threshold customization
  • Monthly external audits

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