Utilization Management

One of the most important value added services that LCP will offer to MCO/HMO Programs is the ability to manage utilization for a traditionally challenging member population. This management expertise will allow LCP and MCO/HMO Programs the ability to provide better service. Managing this population requires a trained staff that understands the Medicaid rules and consistently enforces them. Therefore, staff members are trained to identify certain situations that could be potential avenues for abuse. LCP manages transportation utilization as a “gatekeeper” and coordinate support services through the MCO/HMO when needed for the Medicaid members.

LCP utilizes a state of the art information technology transportation system based on a relational database that will provide our utilization management staff with the necessary reporting capabilities to track and react to potential abuse. The technology allows the staff the ability to identify high utilization members and providers. The system also allows the staff the ability to confirm scheduled appointments. This confirmation process helps to reduce the number of fraudulent scheduled trips.

Next, the staff is able to identify high non-emergency hospital emergency room trips. This will free up emergency room staff to better service the patients that present with emergency symptoms. Also decreased utilization to the emergency room would significantly reduce health care cost per member for the MCO/HMO.

Finally, the fact that LCP can see all utilization in any defined area helps LCP and its customers to detect certain patterns of abuse and over utilization of transportation services. The system can track members that have a pattern of no-shows, cancellations, excessive trips to the same provider that are outside the norm, out-of-state trips, and long distance trips.