Administrative & Health Systems Services

Administrative & Health Systems Services

Our administrative and health systems services focus on improving care, reducing costs, and alleviating administrative healthcare burdens for our business clients.

These solutions align with value-based reimbursement models and help prevent reimbursement penalties. We assist clients in providing superior care by reducing unnecessary re-hospitalizations and emergency department visits; freeing providers to focus on direct patient care rather than administrative tasks; supporting compliance with claims and billing; providing quality independent medical review solutions and healthcare staffing; and delivering positive, measurable impacts on Star and HEDIS ratings.

Our approach integrates seamlessly with existing client programs and resources to reduce overall healthcare expenditures.

Detailed Services

• Medical Review Solutions: Prime Medical Review Solutions (PMRS), a subsidiary of Prime Care Health Solutions, is an independent peer review organization serving the public and private healthcare sectors. Services include utilization management and external peer reviews. PMRS maintains an extensive pool of clinical peer reviewers in active practice to ensure effective, quality, and timely evaluations.
• Prior Authorization (PA) Management Services: We manage the entire prior authorization process, including PA submission, follow-up, and appeals for denials; peer-to-peer consultations and status updates; pharmacy and medical benefit investigation; enrollment in patient medication assistance programs; and pharmacist consultations for medication alternatives and therapeutic drug monitoring.
• Healthcare Staffing Solutions: We address short-term and long-term absences as well as national staffing shortages. We provide efficient, cost-effective recruiting for Nurses and Physicians, Pharmacists, and Allied-health clinicians. Our meticulously developed resources deliver a broad pool of talented candidates for both temporary and permanent roles.
• Health-Care Cost Management Services: We offer a value-based approach to cost management that maximizes revenue while ensuring compliance. Services include medical claims review and bill audits; recovery services to ensure proper payment for services rendered; and partnerships with qualified vendors to ensure maximum savings without compromising patient care.
• Hospital Re-admission Management Services: We reduce patient readmission rates through clinically based care management and transition of care services. Targeted Intervention: We stratify and focus on the most vulnerable populations. Support Model: Services include discharge counseling, in-person or telephonic follow-ups, care plan reinforcement, triage, and pharmacist-led medication management.