Home > Core Health Services

 
 

Core Health Services

Core Health Services (CHS) is the clinical arm of Core. CHS employs several in-house nurses and falls under the direction of John A. Wells, MD, FACS. Our in-house medical staff provides integrated, proactive medical intervention by assisting plan participants and providing guidance throughout the span of the injury or illness.

Pre-certification, Concurrent Review and Retro Review allow for early identification of catastrophic cases that are referred to Large Case Management. Disease Management and oversight of the Patient First prescription drug program provides lifestyle changing information and motivation for those with chronic conditions to prevent costly and catastrophic complications.

With medical costs representing approximately 92% of the overall cost of healthcare benefits, Core’s team of nurses and medical professionals work diligently to review your employee cases to assure quality care at the lowest possible cost. Acting as both patient advocates and employer proponents our medical team manages individual catastrophic large cases and individual long-term chronic diseases. The outcomes are better healthcare and lower costs for both employer and employee.

Our Services Include:

  • Utilization review
  • Case management
  • Disease management
  • Wellness program
  • PPO Network Access
  • Out-of-Network negotiations
  • Pre-certification for in-patient and out-patient services
  • Hospital bill audit
  • Management reports
  • Appeal process
  • Peer review
  • Directed second surgical opinion
  • Employee communications