Utilization Review/Case Management
American Health Holding, Inc. SIIA Member
Nichole Jones, Sales and Strategy Consultant
7400 West Campus Road
New Albany, OH 43054
Phone: (866) 614-4244
Email: ahhinfo@ahhinc.com
Website: www.americanhealthholding.com
American Health Holding, Inc. is a URAC-accredited, national medical management company providing comprehensive, integrated solutions that support millions of members across the health care continuum. American Health delivers health care cost savings through flexible solutions, clinical expertise, leading proprietary technology and advanced reporting, while improving the quality of care.
Aratai International, LLC SIIA Member
Sheryl Wainwright, President/Chief Executive Officer
P.O. Box 911682
St. George, UT 84791
Phone: (888) 448-2470
Email: sheryl.wainwright@arataiinternational.com
Website: www.arataiinternational.com
Aratai International provides expert utilization management, case management, claims audit, data analysis, and predictive modeling services to self-funded insurers and captives. Our team of highly experienced staff have provided services for over 20-years, and we invest time in understanding each organizations goals, and we customize services to meet your needs.
ASCENDpbm
Rob Church, Vice President, Sales - East
6480 Technology Avenue, Suite A-103
Kalamazoo, MI 49009
Phone: (833) 200-5040
Email: r.church@ascendpbm.com
Website: www.ASCENDpbm.com
ASCEND transforms your strategic advantage by collaborating across the healthcare continuum to align diagnostics and therapeutics with prescribing to drive better clinical outcomes and superior value for all. Specializing in pharmacy benefits, ASCEND delivers innovative, patient-focused solutions to contain cost, revolutionize spend, and optimize patient outcomes.
CompAlliance SIIA Member
Linda Van Dillen, Vice President Communications
6700 Antioch Road, Suite 460
Merriam, KS 66204
Phone: (913) 815-6162
Email: lvandillen@compalliance.com
Website: www.CompAlliance.com
CompAlliance is a URAC accredited provider of Medical and Vocational Case Management, UR/UM, 24/7 Triage, Transitional Duty, Ergonomic Assessment, Surgical Cost Projections, Bill Review, PPO Networks and Data Analytics. We provide these services in an ethical, collaborative, cost-effective manner, benefiting all stakeholders.
Considine & Associates HealthClaim Solutions® SIIA Member
James Considine, MD, MBA, President and Chief Executive Officer
25401 Cabot Road, Suite 200
Laguna Hills, CA 92653
Phone: (949) 470-1800
Email: jimconsidine@healthclaim.net
Website: www.healthclaim.net
Considine & Associates HealthClaim Solutions® provides exceptional medical claim solutions for group health, workers’ comp and excess payers. Medical appropriateness, cost analysis and individualized claim payment recommendations are provided in the setting of a URAC-accredited IRO. Hospital/facility bill review is provided on a flat-fee non-contingent basis.
EHO SIIA Member
Nicholas Opalich, Chief Executive Officer
400 East Central Avenue
Belton, TX 76513
Phone: (800) 650-1817
Email: support@ehorx.com
Website: www.ehorx.com
Founded in 1993, EHO combines technology with exceptional customer support to manage patient/member Rx benefit programs while providing innovative solutions to control plan costs. EHO supports its self funded clients by leveraging its proprietary, cloud-based PBM360™ claims processing platform and constructing custom plan designs tailored to its clients’ needs.
Gilsbar SIIA Member
Doug Layman, President of Health & Life
2100 Covington Centre
Covington, LA 70433
Phone: (800) 445-7227
Email: gilsbarmarketing@gilsbar.com
Website: www.Gilsbar.com
For more than half a century, Gilsbar has offered services and solutions for businesses looking for happier constituents and healthier bottom lines. As one of the nation’s largest privately held health and benefits management organizations, Gilsbar delivers an unwavering commitment to partnerships guided by a corporate vision focused on the clients we serve—employers, brokers, consultants, affinity groups, insurance carriers and more. These professionals choose Gilsbar for our innovation, ingenuity, knowledge and world-class service. Our expertise makes Gilsbar the trusted choice for clients across the nation.
HealthSmart SIIA Member
Ron Wozny, Vice President of Marketing
222 West Las Colinas Boulevard, Suite 500N
Irving, TX 75039
Phone: (214) 574-2362
Email: ron.wozny@healthsmart.com
Website: www.healthsmart.com
HealthSmart is one of the largest third party administrators of self-funded health plans and the premier provider of innovative, customizable healthcare and claims solutions for employers, brokers and payers. We offer benefit administration, pharmacy solutions, provider networks, care management and wellness programs, as well as claims and administration services for property, casualty and workers’ compensation.
Hines & Associates, Inc. SIIA Member
Anna Hansen, CSFS®, Director of Sales and Client Solutions
115 East Highland Avenue
Elgin, IL 60120
Phone: (800) 735-1200 Ext. 3702
Email: ahansen@hinesassoc.com
Website: www.hinesassoc.com
Hines & Associates, Inc. celebrates over 30 years! Independent, leader in Medical Management. Stop Loss preferred due to Consistent Results. Customized services. Excellence in Total Population Management. Precertification / Utilization Management, Advocacy and Care Coordination, Specialty Case Management, Healthy Tomorrows Prevention, Chronic Condition Management, Reference Base Price Coordination, Onsite Lab and Biometric Screenings; URAC accredited.
MCA Administrators, Inc. SIIA Member
Charles Davidson, President
1910 Cochran Road, Suite 605
Pittsburgh, PA 15220
Phone: (412) 638-3694
Email: ced@mcoa.com
Website: www.mcaadministrators.com
SBA Certified Small Woman Owned Business. TPA for over 40 years. Processes all lines of medical, dental, vision, FSA, HRA, Taft Hartley, UR/UM. Willing to act as subcontractor/vendor for RFPs requiring minority or women owned participation.
MCM Solutions for Better Health SIIA Member
Gloria Mejia, Director of Client Services
200 West Monroe Street, Suite 1850
Chicago, IL 60606
Phone: (800) 367-9938 Ext. 224
Email: gmejia@medicalcost.com
Website: www.medicalcost.com
Are you positive that the health care benefits you are receiving are right for you? MCM Solutions for Better Health takes pride in our seamless implementation of progressive solutions for our clients. Our 30 years of experience consisting of utilization management, case management, disease management, and wellness programs gives our clients access to absolute optimal health care. With our history of longevity in the industry, we have established successful relationships with the best-in-class TPAs, brokers, reinsurance carriers, reference-based pricing and cost containment companies across the U.S. The ability to work closely with our vendor partners gives us the unique opportunity to create the optimum comprehensive healthcare solution for our clients. Let us do the work for you! Learn more about MCM Solutions for Better Health at www.medicalcost.com.
MedWatch, LLC SIIA Member
Nancy Aguirre, Manager Business Support & Medical Bill Review
400 Colonial Center Parkway, Suite 320
Lake Mary, FL 32746
Phone: (321) 249-9172
Email: nancy.aguirre@urmedwatch.com
Website: www.urmedwatch.com
MedWatch provides URAC Accredited Population Health Management services for Utilization, Case and Disease Management, plus innovative cost saving solutions that include bundled programs for MH/SA-Pharmaceutical Treatments-Surgical procedures. Additional ancillary services addressing industry needs include Member Concierge, RBP, Medical Transportation Cost Management, ESRD, Kidney Care, Diabetic Monitoring and more.
MINES and Associates, Inc. SIIA Member
Dani Kimlinger, Chief Executive Officer
10367 West Centennial Road
Littleton, CO 80127
Phone: (800) 873-7138
Email: dckimlinger@minesandassociates.com
Website: www.minesandassociates.com
MINES & Associates is a national behavioral healthcare firm with almost 40 years of experience providing cost-saving managed care and risk management strategies. Our Specialty Network of Behavioral Health providers reduces healthcare costs for organizations of any size or industry.
Nova Healthcare Administrators SIIA Member
Todd Martin, National Sales Director
6400 Main Street, Suite 210
Buffalo, NY 14221
Phone: (716) 932-5105
Email: tmartin@novahealthcare.com
Website: www.novahealthcare.com
Nova offers personalized service with a tailored approach to cost management and customized, actionable strategies to improve health plan performance. Beyond traditional administrative services, Nova supports plans with DPC and RPB leveraging in-house medical management, HSA, FSA and HRA products. Nova also provides a variety of private-labeled solutions.
NTT DATA Services SIIA Member
Anna Mathy, HealthCare Staffing Services Senior Director
P.O. Box 597
Muskego, WI 53150
Phone: (414) 248-6419
Email: Anna.Mathy@nttdata.com
Website: www.nttdataservices.com/healthcarestaffing
NTT DATA can meet your healthcare staffing needs. Whether you need assistance with business continuity issues or seasonal surges in volumes, NTT DATA provides the staff you need, when you need them, and where: onsite, remote, onshore or offshore. NTT DATA provides business solutions for TPAs, PPOs and health plans.
OptiMed Health Partners SIIA Member
Rusti Greis, Director, Industry Relations & Market Access
6480 Technology Avenue, Suite A
Kalamazoo, MI 49009
Phone: (877) 232-2857
Email: rgreis@optimedhealthpartners.com
Website: www.OptiMedHealthPartners.com
OptiMed Health Partners specializes in ensuring competitive and innovative cost containment strategies focused on specialty pharmacy and clinical programs that not only minimize the price you pay, but maximizes the value you receive.
Orchard Medical Consulting
Christine Cody, National Sales Executive
P.O. Box 54846
Phoenix, AZ 85078
Phone: (480) 848-7210
Email: jtincker@orchardmed.com
Website: www.orchardmed.com
Orchard Medical Consulting is an industry leader for outcome driven case management and award winning customer service in the Southwest. As an unbundled case management provider, we offer services ranging from field case management and catastrophic assignment to return to work coordination; saving our workers compensation clients valuable time and money.
Payer Compass SIIA Member
Kellie Jackson, Vice President, Sales and Client Engagement
5800 Granite Parkway, Suite 450
Plano, TX 75024
Phone: (833) MY.PAYER
Email: info@payercompass.com
Website: www.payercompass.com
Follow the leader in innovative reimbursement strategy. We provide healthcare cost containment solutions with best-of-breed technology for Medicare, Medicaid, Commercial and RBP plans. We champion the initiatives of Third-Party Administrators, Self-Insured Employers, Benefit Advisors, Health Plans and Stop-Loss Carriers, building trust and credibility with plan savings of 65%+.
Prairie States Enterprise, Inc. SIIA Member
Felicia Wilhelm RN, Chief Executive Officer
35 East Wacker Drive, Suite 3200
Chicago, IL 60601
Phone: (312) 464-1888
Email: fwilhelm@prairieontheweb.com
Website: www.prairieontheweb.com
Health Benefit Plan Third Party Administration (TPA) Services for Self-Insured Organizations with Health Management Services by RNs, Wellness Programs, Consulting, Data Analytics, Risk Mitigation &Predictive Modeling. Services include Medical, Dental, Vision, Disability, Hospital Bill Audit, and more. Trend maintained at 2.6% for 10 years. 99% financial accuracy rate guaranteed.
Renalogic SIIA Member
Jim Wachtel, Executive Vice President, Sales and Marketing
22601 North 19th Avenue, Suite 230
Phoenix, AZ 85027
Phone: (623) 594-3060
Email: solutions@renalogic.com
Website: www.renalogic.com
Renalogic has led the industry for 17 years in dialysis cost containment. Now we are changing how employers think about dialysis. Cost savings is important but cost avoidance is better. Contact us today about our Chronic Kidney Disease Management Program.
The Health Plan SIIA Member
Richard Legg, Vice President
1110 Main Street
Wheeling, WV 26003
Phone: (740) 699-6260
Email: rlegg@healthplan.org
Website: www.healthplan.org
We are a fast growing TPA as well as an insurance carrier, offering fully insured plans, doing government programs administration. Our clinical services are best class in the industry, along with our claims processing, customer service. We have our own Behavioral Health Unit, our own Prescription Benefit Manager.
Valenz, formerly United Claim Solutions SIIA Member
Rob Gelb, Chief Revenue Officer
23048 North 15th Avenue
Phoenix, AZ 85027
Phone: (866) 762-4455
Email: rgelb@valenzhealth.com
Website: www.valenzhealth.com
To deliver the industry’s first complete health administrative ecosystem, Valenz™ brings together provider networks, care management, claims management and assurance services on a single source, end-to-end analytics platform. This fully integrated solution provides a smarter way to manage risks, lower per-employee healthcare costs, and improve quality of care.