Medical Management

The majority of TPA services outsource their medical management and therefore minimize the interaction between employees and nurse. Through our integration with HealthCheck360, SISCO takes a more active approach to medical management with a service model that benefits all.

SISCO’s Model

  • Encourage member communication with the Doctors & Nurses of HealthCheck360
  • Integrate TPA & Medical Management technology to enhance Nurse intervention, timing, and results

SISCO’s Medical Management Services Include:

Case Management

  • Accredited by the Utilization Review Accreditation Commission (URAC)
  • Case Managers are clinically experienced Registered Nurses
  • Collaborate with providers to assess, plan, coordinate, and monitor options and services
  • Case Managers are educated in both medical and insurance processes

Disease Management

  • Integration with health risk assessment results to help identify at risk participants
  • Proactively identify untreated existing or potential medical conditions
  • Monitor medication, labs, and compliance with recommended care
  • Focused on improving health outcomes and preventing complications

Utilization Management

  • Access to Milliman Guidelines for Evidence-Based Knowledge and Best Practices Relevant to a Broad Range of Care Settings
  • Ambulatory Care
  • Inpatient and Surgical Care
  • Home Care
  • Recovery Facility Care
  • General Recovery Guidelines (GRG)