480 New Holland Ave, Suite #7203, Lancaster, PA 17602

Hours : Monday to Friday 8:00 am - 4:30 pm
  Phone : 717-560-9290

Medical Management and Precert

Our program has been certified by the Department of Health as a Certified Utilization Review Entity that is approved to conduct Utilization Review on behalf of Managed Care Plans in the state of Pennsylvania since 1999. We have implemented Utilization Review polices that are both URAC and NCQA compliant and have passed all annual audits by an assortment of insurance payors that are NCQA and/or URAC Certified.  The PHC Medical Management program has been selected by large, well-known regional and national insurers to perform utilization management in Lancaster County for Commercial, CHIP, Medicaid and Medicare Advantage members. In addition to this, the program meets URAC and NCQA Accreditation Standards.

Focused on the individual, medical management’s primary goal is patient advocacy — through education, support and coordinated care. Medical management helps patients, families, physicians and facilities resolve complex issues that might inhibit a patient’s ability to achieve a positive outcome. It’s another reason PHC has been the preferred PPO for over 35 years.

As part of our medical management services, PHC offers programs for Utilization Management, Case Management, Wellness and Quality Management. These programs optimize health resources, assuring that members receive the highest quality and appropriate treatment and services for their unique needs.

PHC’s Utilization Review is a comprehensive program for medical, surgical, psychological and substance-abuse care. It encompasses outpatient services, pre-admission and concurrent review, discharge and post-discharge planning. The care coordinators conduct initial and ongoing reviews to assure that nationally established criteria and standards for medical necessity and appropriateness with the treating provider have been met. To provide the best treatment for each individual, PHC considers all appropriate healthcare alternatives, including hospitals, mental health/substance abuse, rehabilitation services, physical, occupational and speech therapy services, home healthcare services and hospice.