HealthLink’s disciplined approach to fixed payment methodologies, precise modeling/forecasting of rate
changes and actuarial calculations allows us to establish aggressive pricing targets by
market and product.
Inpatient Services:
- Multiple per diem rate structure
- Fixed case rates for high cost services and drugs
Outpatient Services:
- Pricing for surgery centers
- Caps, fixed rates or case rates for certain services
- Fee schedules for diagnostic services
Physician/Ancillary Services
- Fixed fee schedules
- Pricing for surgery centers
- Fixed rates for home health services and dialysis
Health Care Management Program
HealthLink’s Health Care Management Program is an extensive suite of health promotion and
wellness information, case management and care coordination services to help physicians
help their patients achieve optimal health outcomes. The program includes three levels
of services: HealthLink Signature Services; HealthLink Wellness Plus; and HealthLink Personal
Care Resources.
HealthLink Signature Services
Medical Management – HealthLink Medical Management is comprised of two components:
Utilization Management and Case Management.
The URAC-accredited Utilization Management program provides clinical review of the medical
necessity for medical care to help clients determine eligibility in accordance with health
benefit plan provisions and includes the following components:
- Pre-Admission Certification of Planned Hospital Admission
- Notification of Emergency Hospital Admission
- Concurrent Hospital Stay Review
- Discharge Planning
- Pre-Certification of Selected Ambulatory/Outpatient Services
- Pre-Certification of Selected Ancillary Services
HealthLink’s Case Management program is a collaborative process among HealthLink
and other health professionals who manage the resources necessary to support individuals
with catastrophic or chronic medical conditions. Case Management helps the treating
health care professional(s) help the patient achieve optimal and timely medical outcomes.
HealthLink Signature Services also include the following:
- Condition Management Programs – Individualized programs for members
with Asthma, Chronic Obstructive Pulmonary Disorder, Coronary Artery Disease, Diabetes
and Heart Failure.
- MaterniCall™ – Maternity management
program helps participants make informed decisions during pregnancy and after childbirth.
- MedCall® – 24/7 nurse hotline and audio library
of more than 300+ health topics.
HealthLink Wellness Plus
The following programs are offered at no charge to the client or member:
- SpecialOffers Online
Discount Program – Helps promote health and well being. More than 20 third-party
vendors provide discounts on services related to family and home, fitness and health,
and vision/hearing/dental treatment.
- TLC® (The Last Cigarette) – Smoking cessation
program. Members request a TLC quit kit to assist in their efforts to be smoke-free.
The following programs are available on a fee-for-service basis. Please contact a
sales account representative for pricing information:
- Worksite Wellness Programs – Health educators and
registered dietitians visit your workplace to share knowledge on a variety of health
and lifestyle topics.
- Lifestyle Management Programs – Engaging online programs and inspiring coaches use
proactive outreach activities and support strategies to help employees in the areas
of: tobacco cessation, weight management, stress management, physical activity and
diet/nutrition.
HealthLink Personal Care Resources
The following value-added electronic member resources are available at no cost to
clients and members:
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