Page 108 - CHHA Binder 2.3.20

4/11/2019

Managed Care

A health care delivery system that involves specific
cost controls to provide cost-effective health care.

CHHA Clinicians must plot additional visits in the
client calendar in order for RCD to request

authorizationorization for additional visits.

Examples: Blue Cross Blue Shield, Healthfirst, Aetna

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Managed Care Pros & Cons

Pros Cons

 Reimbursement does not
 Evidence-based clinical
criteria (InterQual) cover our per-visit expense
in many cases
 Time spent waiting for an
 Primary & preventative authorization
care may be covered
 If clinical info does not
support decision, insurance
company might not pay us

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