Our Products and Services

Contract with us for any of the following services to reduce / control your claims expense.

• Case Management Services details
• Provider and Facility Network Access details
• Utilization Management Services details

Case Management

• Active management of complex and costly care
• Target catastrophically or chronically ill patients
• Optimum value for clients and reimbursement sources
• Appropriate providers and facilities across the continuum of health care
• Available resources are timely, cost effective, and efficient
• Focus on patient advocacy, communication, education, and facilitation of healthcare services
• Registered Nurses, certified in case management

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Provider & Facility Network Access

Saint Joseph Regional Medical Center-Mishawaka
http://www.sjmed.com

• Joint Camp
• Saint Joseph Imaging Services
  • PET-Scan
• Saint Joseph Heart Center
  • RapidScan
• Inpatient Rehabilitation Center
  • Stoke Unit
• Outpatient Clinic
• Family Birthplace
  • Neo-natal Intensive Care Unit
• Saint Joseph Pain and Integrative Medicine Center
• Saint Joseph Cancer Institute
• Center for Women's Health
• Emergency Department

Saint Joseph Regional Medical Center-Plymouth
http://www.sjmed.com

• Saint Joseph Cancer Institute
• New Beginnings Birthplace
• Rehabilitation Services
• Outpatient Clinics and Testing

Edison Lakes Medical Center
http://www.sjmed.com

• Women's Health and Resource Center
• Outpatient Surgery
• Eye Surgery Center
• Edison Lakes Radiology
• Specialty Physician Care as well as Outpatient Physical Therapy and Rehabilitation

South Bend Clinic and Surgery Center
http://www.southbendclinic.com

• Primary Care Physicians
• Multi-Specialty Physician groups
• Outpatient surgery
• Laboratory and X-ray services provided to South Bend Clinic patients
• After hours clinic provided to South Bend Clinic patients

Allied Physicians Surgery Center
http://www.apsurgery.com

• Outpatient Surgical Services

XRC Medical Imaging
http://www.xrcmi.com/

• Multi-slice CT Scanner
• Screening and Diagnostic Mammography with R-2™ Image Checker
• 3-D Ultrasound (now, you can see your baby's face in utero)
• Digital Radiography (X-Ray) & Fluoroscopy (requiring a lower radiation dose than conventional equipment)
• Digital Bone Densitometry (offering osteoporosis screening and total "body fat" analysis)
• Picture Archival Communications System
• Secure Web Site (providing your physician immediate access to images test results)

McDonald Physical Therapy
(Select Health Network is the only local network offering access to McDonald Physical Therapy).
http://www.mcdonaldpt.com/

• Orthopedic and Sports injuries
• Back, neck, and shoulder pain
• Persistent pain in arms, knees, or hips
• Carpal Tunnel Syndrome
• Reflex Sympathetic Dystrophy
• Myofascial pain
• Headaches-TMJ

Trinity Home Health Services
http://www.sjmed.com

• Fully Licensed, certified and bonded not-for-profit agency
• Providing care to Michiana residents for more than 100 years
• Physical Therapy
• Occupational Therapy
• Speech Therapy

Saint Joseph Physician Network
http://www.sjmed.com

• More than 60 physicians and 200 staff personnel
• 20 locations throughout St. Joseph and Marshall County

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Utilization Management

• Prospective review and precertification for:
  • inpatient services
  • outpatient procedures
  • concurrent reviews
  • retrospective review
• Utilization management of inpatient care including:
  • rehabilitation
  • long-term acute care
  • sub-acute services
• Precertification of outpatient services as directed by plan design may include:
  • surgical and diagnostic procedures
  • referrals to specialists
  • durable medical equipment rental and purchase
  • discharge planning

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The Utilization Management program uses InterQual and SIMs criteria which are nationally recognized criteria for utilization management. The UM program adheres to the strictest applicable guidelines, including state regulations, NCQA guidelines, URAC standards, and evidence-based guidelines. The Utilization Management Medical Director plays an active role in the delivery of UM services, and interacts with network physicians on a regular basis.