Medical management

We provide a wide range of medical management programs designed to support our members at any stage of health. These programs are targeted to specific conditions or are designed to improve or maintain overall health.

The goals of our medical management programs are to:

  • Ensure our members receive appropriate care
  • Assist our members with managing a limited benefit
  • Enable us to be responsible stewards of the cost of health care

Kidney health management

Strive Health is the approved vendor for our kidney health management program, which improves care and outcomes for eligible members with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The program focuses on early detection, proper care and treatment as the most effective approaches to delay the disease’s progression, enabling patients to live better, longer lives. Strive will routinely engage participating members to support their overall health and well-being. Participating members will receive information about dialysis center treatments, in-home dialysis and kidney transplant options.

Note: To ensure best practice and compliance with HIPAA, we have entered into a Business Associate Agreement with Strive. Strive may contact your office to request or share protected health information (PHI) about patients to facilitate these care coordination services and close care gaps. We have authorized Strive to do this, and these requests are permissible without patient authorization under HIPAA.

Physical medicine

We partner with eviCore Healthcare (eviCore) to manage our Physical Medicine program.

Radiology

Carelon administers our radiology program, which reviews services performed in an outpatient, elective setting.

Sleep medicine

We partner with Carelon to manage our Sleep Medicine program.

Cardiology

We partner with Carelon to manage our cardiology program, which reviews outpatient cardiovascular tests and procedures.

Care management

Our case managers are an extension of the member's provider team and support each member in meeting their health care goals. Learn about Care management.

Personalized care support

Read about our palliative care program that focuses on supporting the health care needs of our members and their families at any stage of life or illness.

Pharmacy

Explore our members’ prescription benefits and other medication information. Learn more about special member programs, pharmacy pre-authorization and our formularies.

LabCorp

Laboratory Corp. of America is our lab of choice. We encourage you to refer patients to LabCorp for outpatient lab and pathology services.