Our team of healthcare professionals and administrators, located worldwide, offers a comprehensive range of outsourced clinical and non-clinical administrative services to our clients.
From routine to emergent care, each service is customized to enhance both qualitative and quantitative health outcomes. We are committed to delivering exceptional service to our clients through our expert team of professionals.
Health Coaching
ACS health coaches use a variety of effective techniques, including motivational interviewing and clinical interventions, to actively and safely engage our members in behavior change that leads to improved health outcomes. Our health coaches are highly qualified, certified, and credentialed to guide members with chronic conditions, as well as those at moderate to high risk for chronic conditions. To ensure that we provide personalized care, we use health risk assessments and interdisciplinary care plans to evaluate your members' or patients’ conditions and tailor our services to their specific needs.
Health Risk Assessments
The ACS health risk assessment process is a comprehensive screening tool that includes covering members' medical history, demographic characteristics, and lifestyle. Our assessments include questions about functionality in daily life, pains throughout the body, recent hospitalizations, and preventative care measures. As one of the most widely used screening tools in the field of health promotion, our health risk assessment is often the first step in multi-component health promotion programs. While annual assessments are common, we also conduct assessments after any transition of care to ensure that we provide personalized and effective care to your members or patients.
Intake Coordination
ACS Intake Coordinators play a critical role in managing the onboarding process for our members. Our Coordinators conduct initial screenings of complex case management referrals, confirm services, and ensure that all documentation is clear, concise, and meets regulatory and client standards. With their attention to detail and commitment to quality, our Intake Coordinators help to ensure a smooth and seamless experience for your members or patients as they begin their journey towards improved health outcomes.
Case Management
ACS case management is a dynamic process that involves assessing, planning, implementing, coordinating, monitoring, and evaluating care to improve outcomes, experiences, and value for our members. Our case managers routinely oversee hospitalizations and manage member discharges, working closely with primary care providers to ensure that the best level of care is achieved. They update case notes, provide authorization numbers, and facilitate transportation and transfer between hospitals and skilled nursing facilities as needed. With their expertise and attention to detail, our case managers help to ensure that your members or patients receive the highest quality of care possible.
Utilization Management
At ACS, our utilization management (UM) program is designed to evaluate the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities used by our members under their applicable health benefits plan. Our UM team coordinates doctor's appointments, transportation needs, and hospital discharges ensuring that our members receive the care they need in a timely and efficient manner. Our UM agents also review member eligibility, verify copayments, and make special requests on behalf of members participating in the UM program. With their expertise and attention to detail, our UM team helps to ensure that your members or patients receive the highest quality of care possible while also optimizing the use of healthcare resources.
Customer Services
At ACS, we understand that the health benefits industry requires different levels of customer service, but ultimately, the goal is to increase revenues or decrease operating expenses while providing excellent service to members or patients. Whether our clients need seasonal support, assistance with post-campaign queries, or an extra layer of ongoing support, we offer month-to-month support teams that can flex as their business needs change. With our commitment to personalized service and flexibility, we help our clients to provide outstanding customer service while optimizing their operations.
Diabetes Condition Monitoring
ACS offers an evidence-based clinical program for diabetes management that utilizes device readings and encounter data to provide real-time visibility into glycemic control. Our program combines digital health tools with highly trained clinicians to eliminate guesswork and customize member engagement, guiding necessary clinical interventions as needed. By managing chronic conditions in this way, we can improve clinical outcomes and reduce the costs of care for health plans and self-insured employer group customers. Our approach to diabetes monitoring and management is a proactive and effective way to help your members or patients achieve better health and well-being.
ESRD Transportation and Census Review
ACS ESRD agents specialize in coordinating safe and timely transportation for patients with end-stage renal disease. We work directly with transportation vendors to provide essential patient information, dialysis schedules, and determine the most appropriate facilities for our members to travel to and from. Our ESRD transportation service ensures that members or patients receive door-to-door assistance and that any necessary medical devices or equipment are supplied to them. We prioritize the safety and comfort of our members, and our ESRD transportation service is designed to provide peace of mind for members, patients, and their families.
Claims Processing
The ACS claims processing team is dedicated to ensuring that all high-volume claim requests are thoroughly checked for accuracy, validation, justification, and authenticity. We take great care to review each claim to ensure that providers are paid at the appropriate fee schedule rates. Our team is committed to providing prompt and accurate claims processing to ensure that all members receive the care they need in a timely and efficient manner. Professional and facility claims are reviewed by Medical Director, to review the level of care that is appropriate and facility DRG, SNF, and HH are billed correctly. We have auditors that review the claims for proper bundling, billing, and contracts. Down-coding letters are processed. Appeals and PDR are reviewed and followed CMS and Medical guidelines. We process Direct Member reimbursements and out-of-country claims.
Provider Relations
The ACS provider relations team plays a crucial role in building and maintaining strong relationships with healthcare providers, including physicians, hospitals, and medical facilities that participate in our health plans' provider networks. Our provider relations representatives work directly with providers and their staff to ensure they receive the support they need and to address any questions or concerns they may have. Through regular communication and engagement, we strive to foster strong, collaborative relationships with our provider partners, ultimately resulting in better health outcomes for health plan members.
Credentialing
ACS provider credentialing is a rigorous process that involves verifying and assessing the qualifications of healthcare providers, including doctors, dentists, and other allied professionals. This important step helps ensure that health plan members receive high-quality care from qualified and competent providers. As part of the credentialing process, we review providers' education, training, licensure, and other qualifications to ensure they meet regulatory and industry standards. By carefully vetting our providers, we can maintain the highest standards of quality and safety for our members.
Transitional Care (Post Discharge)
ACS transitional care services assist members during the transition from one phase of treatment to another, such as moving from hospital to home care. The program offers medical, practical, and emotional support to members and their families as they adjust to different levels and goals of care. It is especially beneficial for older adults with multiple health conditions who require healthcare services in various settings to meet their unique needs. For younger members, the focus is on successful transitions from child to adult health services.
Medication Therapy Management (MTM)
ACS offers medication therapy management (MTM) services that begin with an in-depth discussion between a pharmacist or healthcare provider and the member to review their medication profile. These services are tailored to meet the specific needs of each plan. Through the MTM program, members receive a thorough review of their medications and are educated on proper medication adherence to ensure they are taking their medications as prescribed.
Document Acquisition and Management
ACS document acquisition and management services involve the efficient and secure retrieval, processing, and storage of various types of documents, including medical records, claims data, clinical records, and notes. This service ensures that all required documents are properly collected, managed, and stored in compliance with regulatory and client standards.
24/7 Nurse Triage
ACS's 24/7 nurse triage services offer a patient-first model that partners with employers, health plans, physician practices, nursing homes, and health systems. This model ensures that callers have access to clinicians as needed, providing immediate assistance to those who require medical attention.