PrimeDx shares office space with the Boon-Chapman Benefits Department allowing these organizations to work in tandem. Both companies operating on an integrated software platform further enhance this integration, enabling PrimeDx nurses and our claim analysts to share information on a real-time basis.

PrimeDx reviews inpatient admissions to determine medical necessity and appropriate level of care. With its experienced team of registered nurses, PrimeDx maintains an excellent average length-of-stay. PrimeDx also provides concurrent review of inpatient admissions. This process monitors on-going admissions for the purpose of ensuring previously approved days are maintained or are adjusted if subsequent clinical circumstances dictate. For many plans, PrimeDx also provides pre-authorization review of designated outpatient procedures using medical criteria to determine appropriateness. These are procedures where utilization management has been shown to be cost effective.

PrimeDx aggressively seeks and pursues case management opportunities. These are identified in three main ways. First, PrimeDx nurses look for case management potential when they evaluate proposed treatment during the pre-authorization review process. Second, PrimeDx runs a report of designated diagnosis codes on claims processed by us every day. These are codes indicating the need for potential case management. Third, PrimeDx generates a weekly report of all cases from the previous week for follow-up.

Once a case management opportunity is discovered, PrimeDx attempts to identify quality, cost-effective treatments. Next PrimeDx works to implement and coordinate these services through physicians, nurses, social workers, discharge planners, family members and the patient. Sometimes alternative treatment plans are implemented; other times negotiated pricing is obtained. PrimeDx case managers maintain a positive professional relationship with health care providers, which is essential to effective case management.

PrimeDx operates a Prenatal Risk Management Program that has a primary objective of identifying high-risk and moderate-risk pregnancies. PrimeDx nurses take an extensive medical history of expectant mothers to identify abnormal risks. PrimeDx follows this with a letter describing the program. Frequent monitoring of high-risk pregnancies ensures these expectant mothers are receiving proper prenatal care. This process enhances the probability of a healthy, full-term baby.