Customized Solutions - American Health Group
 
 

Utilization Management
American Health Group (AHG) is dedicated to ensuring our employer groups pay only for medically appropriate healthcare. Our Utilization Management (UM) Program is led by American Health Group’s physician staff, ensuring employees receive high-quality care with the best possible outcomes.


 
 
Ensuring Clinical Excellence

  • By implementing a Utilization Management Program, employer groups are guaranteed board-certified medical oversight. Combining this program with 100% claim review, American Health Group has consistently uncovered excessive and unnecessary charges. Our integrated approach produces significant cost compression of overall healthcare spending.

 
 

Utilization Management Solutions include:


 
 
Pre-Certification

  • Inpatient hospitalization
  • Long-term inpatient care
  • Inpatient/outpatient psychiatric, chemical abuse & addiction conditions
  • Elective surgical procedures
  • Select outpatient procedures
  • Home healthcare services and supplies
 
 
 
 
"Best In Class" Service

  • 100% Board Certified Physician Review
  • Bachelors Prepared-Registered Nurses for guidance and support
  • Healthcare Coaches educate and assist employees
  • Milliman Care Guidelines resource materials
 
 
 
 
Utilization Review

  • Pre-admission review based on accepted medical practices and standards of individual community
  • Medical necessity verification for a continued stay
  • Patient care assessment to determine alternatives for treatment
  • Claim review to ensure appropriate care was given and accuracy of billed charges
 
 
 
 
Case Management

  • Identify catastrophic illness or injury
  • Assist employees in identifying additional resources that may be available
  • Offer AHG’s national “Centers of Excellence” for referrals on complex cases
  • Monitor improved standards of care at each hospital
  • Review and negotiate on high dollar cases
 
 
   

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