Precertification and Utilization Review services are available on a capitated (per employee per month - PEPM) basis. Based upon the size of the covered group, and the other BMS CareConnex™ modules which have been selected, following is a summary of the PEPM fees:

• Inpatient Utilization Review - fees begin at $1.50 PEPM for employers with under 200 employee plan participants, and decrease to as little as $.75 PEPM for employers with more than 2500 employee lives.
• Outpatient Utilization Review – fees begin at $1.25 PEPM for employers with under 200 employee plan participants, and decrease to as little as $.65 PEPM for employers with more than 2500 employee lives. Because outpatient review is tailored to suit each client’s plan, these fees may vary based upon frequency and severity of the requested review method.

Case Management at hourly rates

Catastrophic Case Management, Pre-Natal Wellness, Disease Management, and Disability Management services are available on an hourly basis, billed at $125 per hour, in 5 minute increments. Based upon the comprehensive scope of these BMS CareConnex™ services, a plan should expect to invest approximately ½ to ¾ of 1% of the overall medical and drug claims expenditure for Catastrophic Case Management, and about the same again for Disease Management services.

Automated, efficient, effective screening

Utilizing our proprietary AutoTrigger™ program, claims data are screened on a daily basis for potential candidates. Once a member has been identified by AutoTrigger™, he or she is automatically referred to one of our clinical staff nurses for review and assessment. Upon this referral, a preliminary screening charge (equivalent to only 5 minutes of billable time) is incurred. Following the assessment, the member is established as either active status or closed status. Active status indicates that Case Management or Disease Management will commence immediately. If the member is “closed”, they are only re-evaluated if AutoTrigger detects another different critical diagnosis, or if it detects a recurrence of the same diagnosis within 90 days of the initial referral.