| Goods and Services | Managed care management services to independent physician associations (IPAs) and hospitals; Consulting services in the fields of independent physician associations (IPAs) operations management and hospital operations management; Business management and consulting services for independent physician associations (IPAs) and hospitals, namely, accounting services, financial management services; Utilization management services, outpatient review services, inpatient review services, patient care quality management services, provider network operations services, health plan eligibility and benefits services, practitioner credentialling services, call center services, medical claims management services; Healthcare utilization management services, namely, establishment and implementation of written utilization management protocols and criteria applicable to medical necessity review, providing patient treatment options to healthcare practitioners, review patient hospitalizations, discharge planning, evaluation of practice patterns, identification of care variation, and compliance with regulatory turnaround timeframes for independent physician associations (IPAs) and hospitals; Healthcare quality management services, namely, the collection, reporting, and analysis of healthcare quality data for independent physician associations (IPAs) and hospitals; Operation of telephone call centers for independent physician associations (IPAs) and hospitals, namely, providing customer service assistance with utilization management and insurance claims and benefits information to healthcare practitioners and patients; Medical claims management services, namely, receiving, data entering, routing and adjudication of medical claims originated by independent physician associations (IPAs), hospitals, and ancillary medical care providers; Professional credentialing verification and monitoring services in the field of healthcare, namely, verifying the skills and knowledge of licensed professionals on behalf of independent physician associations (IPAs) and hospitals; Healthcare provider network operations (PNO) and management services, namely, providing healthcare provider network organization, management, coordination and administrative support services to independent physician associations (IPAs) and hospitals; Management of healthcare case management and transition of care services, namely, facilitating, assessing, and coordinating medical and personal care services between independent physician associations (IPAs), hospitals and patients and their family members; Consulting services in the field of patient relationship management for independent physician associations (IPAs) and hospitals; Health plan tracking and information services, namely, tracking and maintaining current and historical eligibility information concerning contracted health plans for independent physician associations (IPAs) and hospitals; Business management and consulting services in the field of financial management, namely, providing accounting and financial tracking and reporting services to independent physician associations (IPAs) and hospitals; Business management and consulting services in the field of hospital operations, namely, advising and assessing the management of risk pools and continuity of patient care for hospitals |
