GUARDCo provides healthcare management services and provider networks on behalf of insurance companies for use in addressing claims from their commercial customers in select states.
In writing policies, insurance companies typically provide both coverage AND a bundle of necessary value-added services. As an organization involved in helping insurers adjust claims efficiently and effectively, GUARDCo is a key strategic partner for a variety of medical management activities. Since enabling legislation for managed care varies greatly by jurisdiction, GUARDCo’s approach does as well and can include:
- Overseeing the efforts of third-party vendors;
- Serving as a Utilization Review Agent (in the case of Massachusetts) and/or Managed Care Organization (MCO) when appropriate;
- Performing telephonic case management (using in-house registered nurses) where permitted by law;
- Reviewing new claims and entering appropriate diagnoses via a proprietary, state-of-the-art claims management system;
- Involving (when appropriate) contracted medical consultants and/or a Medical Director in the process;
- Providing access to preferred providers and acting as an MCO in relevant circumstances;
- Helping to implement an aggressive prescription management program to contain rising costs and over-utilization.
We encourage interested parties to request more information about GUARDCo’s role and long history in serving insurers.