| Comprehensive and integrated
BMS CareConnex™ is a comprehensive, integrated medical care management system, designed to support the cost-containment and quality improvement objectives of self-insured health plans and the administrators of those plans.
Collaborative process
Care Management is a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual’s health needs, using communication and available resources to promote quality, cost effective outcomes. BMS CareConnex™ services are delivered exclusively by Registered Nurses (RNs) and Certified Case Managers (CCMs) with an average of 19 years of case management experience, and supported by industry leading evidenced based clinical guidelines such as Milliman. BMS CareConnex™ staff help the patient maximize the efficacy of their medical treatment, and enhance recovery, thereby preventing complications and avoiding potential costs associated with extended or failed recovery or disease maintenance.
Access to many specialist physicians
BMS CareConnex™ is affiliated with several national and fully accredited independent Peer Review Organizations (PROs) that provide our clinical staff with access to over 100 board-certified physician specialists and sub specialists. During the care management process, these specialists provide timely, pertinent, and independent assessments of the member’s patient’s treatment plan. Typically, these services are utilized only when we have a question or concern over the member’s patient’s current or proposed course of treatment.
Prompt clinical review protocol
BMS CareConnex™ is focused upon providing accurate and timely clinical reviews. Our review protocol mandates that all internal determinations are made within one business day of receipt of information. External determinations (those requiring a referral to our external independent PROs) are completed within two business days. This turnaround meets or exceeds any national accreditation guideline and provides superior member and provider satisfaction.
BMS CareConnex™ Mission Statement
Our Mission at BMS CareConnex™ is to:
- facilitate and promote the delivery of superior quality, and cost effective health care within the guidelines of the patient’s benefit plan;
- frequently communicate with the patient and applicable family members to promote an understanding of the clinical aspects of the current and proposed course of treatment;
- provide support and guidance to the patient and applicable family members due to the psychological and economic impacts of a catastrophic illness or injury;
- Provide comprehensive and timely clinical updates to the authorized payor or plan administrator to facilitate efficient and accurate plan administration services.
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Six integrated care management modules
BMS CareConnex™ is comprised of six distinct service modules, as listed below and described in more detail on the following page. All modules are fully integrated and best utilized as a “package”, however each module may be elected on a stand-alone basis as determined by the unique needs of each self-insured plan and/or plan administrator. BMS CareConnex™ Care Management Modules include:
Formal appeals process
Our care management process is founded upon collaboration and non-confrontation with the patient’s physician providers. However, it is not uncommon for the review process to yield a “non-certified” decision. If the patient, insured member, or medical provider disagrees with our decision, our appeal process may be utilized. Our appeal process assures objective, fair treatment of all parties, and meets all legislative requirements. |
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