Medical Management

Medical Management Solutions (MMS) is a division of HealthFirst TPA. This team of registered nurses, certified case managers and a medical director has years of experience in healthcare and managed care. Through HealthFirst, MMS contracts with employers for utilization and case management for self-funded employer groups – current and retired employees, who underwrite insurance for their employees.

Overseeing and controlling medical costs of claims, MMS staff focuses their efforts where they can have the greatest impact on health outcomes and preventable spending. Using predictive analytic modeling, they can identify members most likely to experience serious and preventable episodes. The staff then collaborates with providers to assess, plan, coordinate and monitor options and services, always with a focus on the individual, striving to provide the highest quality services possible.

Among the services offered by MMS are:

  • Precertifications when required for any healthcare services
  • Disease management focused on improving health outcomes and preventing complications
  • Case management when members have a serious illness or diagnosis and require extensive healthcare services
  • Medical bill review and verification, including appeals

MMS can help members get healthy, stay healthy, and manage chronic conditions. Combining insight and compassion to help care for both the population and individual, their mission is to enhance the lives of clients by coordinating the delivery of quality care and to achieve optimal patient outcomes in a cost-effective manner utilizing a multi-disciplinary approach.