Healthcare Management for Utilization/Pre-Certification Review
Effective November 22, 2008, Trustmark has moved the pre-certification program under CoreSource Healthcare Management (HCM). This decision comes after extensive review of our options. Through the HCM program, which is a patient-centered process designed to coordinate and monitor care during hospitalizations, Trustmark will be able to further promote and manage towards appropriate and cost-effective healthcare for our insured population.
This decision has not resulted in any changes to the current 800 numbers located on the back of the ID cards. Providers and members will utilize those identified numbers to call in for pre-certifications. The pre-certification program requirements will remain unchanged. HCM will continue to base the certification of days and validate savings achieved using Milliman USA criteria.
HCM is fully accredited by the Utilization Review Accreditation Commission (URAC).
UR/Pre-Certification Program Components
Inpatient Hospital Confinements
Skilled Nursing Facilities
Hospice
Home Health Care Services
Long Term Care/Sub-Acute Inpatient Medical & Rehabilitation
Maternity based on length of stay 4+ days/High Risk
Behavioral Health Treatment
To help better understand this change, here are some Q & A’s should they arise.
Q: Why did Trustmark make this move and who is Health Care Management (HCM)?
A: Trustmark moved its pre-certification program under CoreSource a sister company of Trustmark. This decision comes after extensive review of our options. By moving to the HCM product, Trustmark will be able to take advantage of the common vision offered through its sister company. It will allow Trustmark the ability to further expand upon our commitment to the integration of care continuum. Through Healthcare Management’s patient-centered process, which is designed to coordinate and monitor care during hospitalizations, Trustmark will be able to further promote and manage towards appropriate and cost-effective healthcare for our insured population.
Q: What is the benefit of having HCM perform the utilization/pre-certification program?
A: HCM will be managing our cases towards the Milliman Care Guidelines for Moderately Managed Delivery System. HCM will continue to strive to achieve reductions in days/1000, admits/1000 and Average Length of Stay over those historically achieved.
Q: Did the 800# change on the ID card be changing?
A: No, the existing 800 numbers will not be changing. There will be some different call prompts that the callers will need to listen to make a correct choice. They are very similar to those currently in place.
Q: Will the network be changing as a result of this?
A: No. This does not affect your network
Q: What is the effective date of the change?
A: November 22, 2008.
Q: Has there been any changes to the pre-certification requirements?
A: There is no change to the pre-certification requirements for providers and/or members.
Q: What system applications will the Benefit Division use to verify the number of certified days?
A: The Patient Note application will still populate the number of certified days for cases that require pre-certification.
Q: Will there be changes to the Vendor table to reflect HCM at this time?
A: No, not at this time. The UR vendor will still show “PHS” however services will be performed by HCM and payments will be made to an HCM account.
Q: Will HCM require a Network Notification Form?
A: YES, this process will continue until further notice. Please use the new Network Form entitled HCM Network Notification Form. The HCM Notification Form is located under Business Tools: Managed Care/Managed Care Administration/Network Notification and Changes Form Process tab. Forward the completed HCM Network Notification Form in an email to: HCM Network Notification.
We look forward to our new partnership with HCM. Should you have any additional questions or concerns, please contact me at extension 32308 or by email at .