HealthCare Insight launches new care management program for oncology claims

Oct 5 2009

HealthCare Insight (HCI), a division of Verisk Health, Inc., and a provider of clinically validated fraud, abuse, and overpayment prevention solutions for private and public-sector payors, announced today the release of a new care management program for oncology claims.

OncologyClaim Insight™, powered by Biologics, Inc.'s best-in-class cancer management strategy for payors, is a prepayment service designed to elevate patient care, enhance provider satisfaction, and manage oncology costs. This new clinically based service has been implemented to help HCI clients reduce the costs of cancer care while realizing an ROI of more than 8:1. Service features include 100 percent oncology case eligibility review, patient management, and education performed by an individually assigned Oncology Certified Nurse (OCN); detailed claim audits; validation and documentation of complex care plans that meet evidence-based national guidelines; access to an expert oncologist advisory panel; and detailed program performance reports.

A key component of the service is to support patients as they navigate the maze of providers and help to avoid potentially dangerous duplicate tests, procedures, or unnecessary and/or inappropriate treatment plans. HCI formed a strategic alliance with Biologics to implement a solution that results in appropriate reimbursement for payors and providers while ensuring that patients receive additional clinical support throughout their treatment.

"OncologyClaim Insight assures the employer, payor, and patient that the most appropriate plan of treatment is delivered and that patients receive a high level of clinical support to give them the best opportunity for a positive outcome," said Brian Smith, executive vice president of sales for HealthCare Insight.

"We are honored to provide the clinical oncology expertise for OncologyClaim Insight," said Robin U. Smith, chairman and chief executive officer of Biologics, Inc. "HCI is progressively addressing the complexities of cancer care to serve its payors, providers, and, most important, the patients."