Clinical Risk & Medical Management

Clinical Risk & Medical Management

Our Clinical Risk & Medical Management team is dedicated to working in partnership with you to manage claims and decrease risk for all of our Accident and Health partners.

 

Contact

Clinical Risk & Medical Management
Merry Gann
[email protected]

Debra Fatovic
[email protected]

Contact our Team
[email protected]

General Inquiries
[email protected]

Downloads
C&F ReClaim Brochure
C&F ReClaim Referral Guide
C&F ReClaim Referral Form

Solutions & Services
Stop Loss & Excess Medical
Ancillary & Supplemental Benefits

C&F ReClaim

We assist our clients with reducing healthcare spend and can significantly impact high-cost claims while maintaining or improving medical outcomes. C&F ReClaim is more than just cost containment for stop loss and specialty risk programs such as student and travel-related claims. Read below to understand what C&F ReClaim can do for your organization.

C&F ReClaim:

  • Combines the expertise of our in-house clinical professional team with a select group of top medical management vendors
  • Includes bill reviews to identify billing errors and negotiations with providers for both in and out of network claims when prices are outside our cost guidelines
  • Is aimed at improving and managing costs
  • Allows you to reclaim control over your large-claim exposure

 

  • Is built to complement any existing medical claims management program
  • Improves overall transparency of price versus cost of healthcare
  • We stay involved throughout the process to assist with providing comprehensive solutions that result in improved clinical outcomes.

We work for and on behalf of our clients and policyholders by:

  • Providing experienced nurses for Consultations when questions arise or additional information is needed regarding treatment being provided or cost
  • Limiting claim expense from a management and a bottom line standpoint
  • Determining the best financial outcomes and cost savings for the policyholder

Medical Cost Containment

  • ESRD/Dialysis
  • Neo-Natal
  • Cancer
  • Specialty Pharmacy
  • Prolonged Hospitalizations
  • Hemophilia
  • Organ Transplant
  • Behavioral Health Management
  • Rare Diseases, such as HAE
  • Gene and Cell Therapies
  • CAR-T Cell Therapies

Advisory & Consulting Services

  • Medical necessity review
  • Experimental investigation review
  • Transplant network contract analysis
  • High-cost specialty drug review and management
  • Egregious billing review and management
  • Assistance with early identification of complex cases
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