What Is a Managed Care Support Contractor

As healthcare costs continue to rise, more and more insurance providers are turning to managed care support contractors to help manage their costs and improve the quality of care for patients. But what exactly is a managed care support contractor, and how do they help insurance providers meet their goals?

In simple terms, a managed care support contractor is a company that provides administrative and operational support to insurance providers who offer managed care plans. Managed care plans are insurance plans that aim to control costs by limiting the amount of care that patients can receive from certain providers and requiring pre-authorization for certain services.

Managed care support contractors help insurance providers implement and manage their managed care plans by providing a range of services, including:

1. Network management: Managed care support contractors help insurance providers build and maintain networks of healthcare providers who agree to offer their services to plan members at discounted rates. They also negotiate contracts with providers to ensure that costs are kept under control.

2. Utilization management: To control costs, managed care plans often require pre-authorization for certain medical services, such as hospital stays or surgeries. Managed care support contractors help insurance providers manage these authorizations and ensure that the right care is being provided at the right time.

3. Case management: For patients with complex medical needs, managed care support contractors provide case management services to ensure that they receive appropriate care and avoid costly hospital readmissions.

4. Quality management: Managed care support contractors help insurance providers monitor the quality of care being provided by their network of providers. They may also provide education and training to providers to ensure that they are meeting quality standards.

Overall, managed care support contractors play a crucial role in helping insurance providers manage their costs while providing high-quality care to patients. By leveraging their expertise in network management, utilization management, case management, and quality management, these contractors help insurance providers meet the demands of today`s healthcare landscape.