Rehabilitation Solution
Support your members’ functional improvement
As part of an overall medical benefits management approach, our Rehabilitation Solution helps your health plan support better outcomes while managing the cost of rehabilitation therapy. We partner with providers and combine evidence-based clinical guidelines, utilization review, and clinical expertise to help members receive appropriate physical, occupational, and speech therapy in the right setting.
Lines of business
- Commercial
- Medicare
- Medicaid
- Federal employee
How rehabilitation management can support outcomes and the total cost of care
Rehabilitation can help people achieve better functional outcomes. And when managed at scale with clinical integrity, it can support more consistent, evidence-based care — helping health plans improve care quality and manage the total cost of care.
Support your members’ functional outcomes
After an illness or an injury, rehabilitation therapy can help members regain function and get back on their feet. We help make it possible. Through our Rehabilitation Solution, we help support care that aligns with each member’s needs so they can receive effective, clinically appropriate rehabilitative treatments.
Guide your providers’ decision-making
Throughout the care journey, your providers face many decisions — from the type of therapy to the setting and duration. We help bring clarity to them. As your strategic partner, we help your providers adopt evidence-based care.
Help reduce your health plan’s total cost of care
Demand for pain management and rehabilitation keeps rising. We help reduce unnecessary spending on it. We support informed treatment decisions that can help reduce extended or ineffective courses of therapy and inappropriate surgeries, while promoting more appropriate use of health plan resources.
What’s included in our Rehabilitation Solution
Effective rehabilitation management requires more than reviewing individual requests. Our Rehabilitation Solution brings together clinical expertise, provider collaboration, and data-driven insights to help your health plan guide care from the initial request through treatment.
Clinical appropriateness review
Clinical setting optimization (optional)
Specialty-matched provider consultation
Practice engagement resources
Advanced analytics and reporting
How rehabilitation management and utilization review work
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria are immediately approved. When additional review is needed, our clinical reviewers, including therapists and board-certified physicians, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Redirect
If included in your program design, we redirect services to high-value sites of care when clinically appropriate.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable.
Ask us about our Rehabilitation Solution
Connect with us to explore the potential impact of our Rehabilitation Solution for your health plan.
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Frequently asked questions about rehabilitation benefits solutions
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.