Commercial Sector

Some of the solutions that PerformCare offers to health plans include:

Care Management

  • We promote lasting resiliency and recovery by providing treatment from point of entry to aftercare.
  • Access to PerformCare is 24 hours a day, 7 days a week, 365 days a year via our live toll-free number.
  • Enhanced care is provided through focused utilization review for targeted levels of care and complex case management as well as integrated medical solutions

Flexible Approaches to Contracting

  • Full-time or afterhours services
  • Adaptability to various Medical Necessity Criteria and benefit plans
  • ASO or Capitated Reimbursement models
  • "Service Menu" flexibility

Claims Processing and Data Management

We have a solid reputation for being among the most prompt and efficient in processing claims. We do this by utilizing:

  • HIPAA compliant processes and transactions
  • Electronic and paper claims processing
  • Custom technology solutions for customers
  • Electronic Funds Transfer (EFT) for claims payments

Provider Network Management

We are highly successful in building provider networks and handling provider operations, including:

  • Network development
  • Credentialing and recredentialing
  • Provider relations
  • Developing and maintaining provider networks according to payer requirements and specifications

Quality Improvement

PerformCare embraces the principles of sustainable continuous quality improvement (CQI) to ensure that services are based on quality improvement benchmarks that enhance holistic resiliency and recovery. The Quality Improvement (QI) program and QI Committee monitors the progress of CQI and reporting across all operations. PerformCare maintains full accreditation from the National Committee for Quality Assurance (NCQA) as a Managed Behavioral Healthcare Organization (MBHO) for Medicaid populations, and meets all NCQA standards for its delegated programs with health plans.

Autism Management and Coordination

We are national leaders in the area of Autism Spectrum Disorders (ASDs); in 2011 alone we managed and served well over 4,200 individuals with autism/pervasive development disorders (PDDs), in careful coordination with their families.

Alternative Services in place for children/adolescents with Autism/PDD

In addition to evaluations, 1:1 intervention and school and home-based services, our other interventions include:

  • autism after-school programs
  • specialized summer therapeutic activities programs (STAP)
  • provision of academic and expert consultation for high risk, aggressive, and self-injurious individuals
  • support for services through a Center of Excellence for Autism
  • support for services in specialized educational settings
  • Family based teams that specialize in autism
  • functional behavioral analysis
  • support for residential placements, when necessary

Utilization Management

Our experience in utilization management has allowed us to achieve substantial savings for our clients. We do this by implementing programs that reduce the need for Emergency Room visits. Additionally, we provide re-hospitalization in services areas that we coordinate within the community setting.

For more information regarding PerformCare's Medicaid solutions, call us at 1-888-700-7370.

Solutions