The most important roles of Certified Case Managers are seen as advocacy, ensuring appropriate care, and educating and empowering clients.
More than 50,000 case managers are certified with the Certified Case Manager® (CCM®) credential. CCM certificates bring immense value within various healthcare organizations and in private practice.
Peak Performance Plus Health Care Advocacy and Case Management services are designed to help insurance beneficiaries and their families obtain quality medical and behavioral health care at affordable rates, improving the outcomes of their care and the quality of their lives. This service also assists facilities and providers in obtaining easy access to credentialing, appeals of denials of claims and the grievance processes which are different for each insurance company.
***Help with an appeal of Enrollment or Re-enrollment: if you miss the enrollment period, you may be excluded from insurance coverage or from having the option to change any or all of your benefits
***Help with navigating the Grievance and Appeal processes. Most Insurance companies require preauthorization of services. If this process is not completed to the specifications of the benefit as written in the policy, there will be a denial of coverage for the beneficiary and provider. for the service. This type of situation can be costly to both the beneficiary and the provider.
***Help in assisting in the process of filing a Request for a Waiver on a policy which would allow the beneficiary to be covered by the policy for exhausted or non-inclusive services avoiding the beneficiary being held responsible for out-of-pocket payment of such services.
*** Help with coordination of Long-Term Care Insurance and secondary insurance benefits with local community resources facilitating a seamless transition from hospital to rehabilitation center and home care.
Get the Right Care; At the Right Time; In the Right Place; To Get the Right Outcome!
Certified Independent Case Managers are the essential link between the patients, family and caregivers to Assess, Plan, Coordinate, Communicate, Advocate, Educate, and Maintain standards of health safety on your behalf through Case Management Assessment and Care Planning.