Medical Case Management services to ensure appropriate care while promoting cost savings.


Our medical case management services ensure that patients receive the appropriate care while increasing opportunities for cost savings.

Our case management team coordinates medical care for pre-planned procedures, suggests treatment options and monitors ongoing medical treatment while directing patients toward high-quality providers with in-network discounts. We evaluate each case using evidence-based medicine and best practice guidelines ensuring that patients are receiving the right care, in the right setting, at the right time.

Our case managers are experts at working with an entire episode of care to foresee billing and care delivery situations that require active monitoring and advocacy on behalf of both the payer and the patient. Our highly effective medical case management solution reduces billing errors, facilitates prompt payment to providers, maximizes opportunities for savings and ensures that patients are receiving the appropriate care.

Highlights of Our Service

  • Concurrent monitoring of patient treatment plans
  • Directing patients to cost-effective providers and facilities
  • Coordination of hospital admissions and appointments
  • Post-discharge planning and care coordination
  • Effective communication between all parties
  • Pre-authorizations of medical treatment
  • Coordination of referrals
  • Coordination of air ambulance/commercial airline evacuation


Who is involved in managing your case?

PayerFusion’s Case Managers are medically trained personnel (doctors and nurses) that are experienced in dealing with healthcare administrative matters and financial best practices. They ensure that the right amount of intensity and urgency are given to each medical case and to each patient receiving treatment. In managing a case, we involve all the relevant parties with a stake in the patient’s outcome, including payers, the patient and family members. We also coordinate with case managers that may be assigned by a provider or facility, ensuring that each stakeholder has up-to-date information as we seek to drive efficiency throughout the continuum of care.

Advantages of Our Medical Case Management Service

  • Case managers provide an accurate evidence-based review of treatment plans
  • Early identification of costly cases allows time for cost saving solutions
  • We focus on the quality of care provided while ensuring timely and cost effective treatment based on medical necessity.
  • Steering of patients to cost-effective facilities