Cost Management Services

Through Technology Driven, Physician-Directed, Medical Management

SIP provides a comprehensive range of cost management services including data analysis, large case management, and sophisticated clinical logic software that carefully examines medical necessity, appropriateness of care and monitors utilization of services. These services are provided by SIP in concert with AWAC.

As a member of the AWAC Alliance of plan administrators, we know the greatest impact on health plan costs is from large individual claims. Our participation in this alliance gives us the interventional tools necessary to provide effective medical and financial management to cut costs and improve patient outcomes.

Electronic Surveillance and Early Identification

This process begins with Advanced Warning and Containment (AWAC®) software. Built around a database of physician-produced clinical and financial algorithms and decision rules, tens of thousands of actual cases and millions of health claims, the program is the only electronic claims surveillance system in existence.

Medical claims data, prescriptions and pre-certification records are securely downloaded every night. By comparing these claims to information in more than 50 separate databases, the software identifies cases that are likely to become catastrophic. AWAC physicians review the identified cases and make recommendations daily, before the claims are paid.

Medical Management

The key to our success with AWAC is a dedicated team of board-certified physicians who monitor the data and serve as on-call medical directors, managing the cases AWAC identifies. Once AWAC identifies a case, their physicians and other team members work with the client, patient and attending physician to ensure the best possible care with optimum savings.

AWAC physicians and consulting specialists also review billing to make sure prices are based on the true costs of care delivered – something they know firsthand. If they identify questionable pricing, they discuss and negotiate physician to physician.

Precertification and Utilization Review

AWAC helps us offer a physician-led precertification and utilization service called iProcert™ which totally integrates utilization management into the AWAC system of cost reduction and disease management options.

These systems are electronically interfaced to AWAC to assure accurate and timely transmission of appropriate and necessary data. AWAC physicians review this data for clinical or financial indicators that predict the need for case management, early discharge planning, long term care needs (inpatient or outpatient), disease management requirements or potential cost containment opportunities, such as pre-negotiating services.

Better Health and Lower Costs

Proprietary AWAC claims review software, physician medical directors, specialty physician-to-physician communications and integrated precertification and utilization management allow AWAC to quickly identify and manage expensive or potentially expensive cases and work with the plan to assure an optimal health outcome for the member.