Gilsbar's Utilization Management program is URAC accredited and follows nationally recognized, evidence-based Milliman care guidelines. Gilsbar's team provides an integrated and systematic approach to the assessment, monitoring and evaluation of key indicators, and improvement of health care services provided to participants. We serve as advocates to participants to help them better understand their benefit plan and the healthcare system. Our nurses answer questions and help guide participants before, during and after medical interactions. We work in a timely manner to avoid delay or disruption of care, and are sensitive to the anxiety that illness can generate. Delivering care with a sincere concern for the individual’ s welfare, our team seeks the best for the patient’s physical and emotional status, as well as the financial impact on the plan.
- Real-time networked software shared among Gilsbar's nurses, claims and customer service units provides faster claims processing, updated patient notes and accurate eligibility information
- Increases health plan value for your company and plan participants by helping to determine the medical necessity of prescribed treatment or care
- Improves health outcomes through personalized care and monitoring
- Helps reduce re-insurance and employee premiums while managing overall health plan costs
- Encourages utilization of in-network providers and services to reduce participant and plan exposure to uncovered charges
- Increases employee satisfaction by offering an enhanced benefits package, attentive service and rapid review of treatments
Gilsbar and MedCom Care Management do not engage in the practice of medicine; nor do they act to impinge upon or encumber the independent medical judgment of treating physicians or other health care providers. Implementation of this program should not be construed to imply otherwise.