Adult Case Management Programs: Covers complex adult case management and the Predictive Model Program.

Benefit Appeals: The appeals process and provider's role.

Healthy Pregnancy Program: A family-centered model that supports the health of pregnant women and their babies in partnership with the health care provider.

Medicare Programs: Services covered by medicare.

Pediatric Case Management Program: Case management of infants or children with special needs.

Restricted Recipient Program: Identifies suspected cases of abuse of health services or prescription drugs by members.

Transplant Case Management: Management of prior authorization requirements for appropriateness of transplant, network status of facility for best member benefit and pre and post transplant services that may be needed by the member.



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