Underwriting Medical Review | Clinical Advisory Service

 

SCM can help you successfully and prudently navigate healthcare insurance risk. We provide you with timely, comprehensive, and highly accurate recommendations for predicting and managing risk. In so doing, we enable you to structure coverage plans and deductibles that retain business, yet minimize catastrophically-expensive claims. SCM enhances and complements your in-house, as well as external resources.

 

To provide these services:

  • We draw upon a vast network of physicians, clinical nurses, and healthcare industry professionals in order to rapidly and accurately analyze cases, and identify the optimal treatment plan and its attendant costs;
  • We continually monitor FDA/EMEA/CMS regulatory and reimbursement approvals for new drug and device indications. This process allows you to anticipate and proactively manage risk, instead of playing catch-up after the high-cost claims are received;
  • We access pharmacy and reimbursement networks to assess which trends in “off-label” and so-called “experimental care” are becoming the “standard of care,” thereby enabling our clients to plan and design coverage parameters accordingly;
  • Our professional peer-to-peer approach (MD-to-MD and RN-to-RN) enables us to test assumptions and understand “true costs” of care sometimes not apparent in the medical records.