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Medical Management

As a managed care organization, SAS understands that one of our greatest responsibilities and the most important aspect of our services is medical management, as it impacts your employees and their dependents the most. Our philosophy is not based on denial of care, but on medically necessary and appropriate treatment and services. To truly reduce claim expense and utilization, a diligent and fair medical management practice must be in place that focuses more on episodic case management, as opposed to simple pre-notification. Medical Management services are performed in-house by SAS employees and are not assessed an additional fee above our General Administrative Fee.

The Medical Management Department holds a Private Review Agency License issued by the State of Mississippi and includes a physician Medical Director and Registered Nurses who provide services in the area of:

  • Precertification / preauthorization
  • Episodic case management
  • Disease-state management programs
  • Retrospective and concurrent review

SAS's Medical Management staff utilizes InterQual® criteria for medical appropriateness and necessity decisions. Unlike other TPAs, SAS's Medical Management Department does far more than simple precertification. SAS has worked interactively with the providers in our networks to refine the preauthorization system to relieve administrative burdens while targeting high dollar and historically over-utilized services. These preauthorization practices allow our case management nurses to be involved in high-risk, expensive cases from the initial admission or diagnosis, which aids in cost reduction and in quality of care improvement for the member. It also reduces the administrative "hassle" managed by our providers. Our Medical Management Department works together with the Network Management Department to ensure that all out-of-network services receive appropriate discounts, and members receive quality services.

Web-based care management programs for members are available for 39 disease states, including:

  • Alzheimer’s Disease
  • Endometriosis
  • Glaucoma
  • Hepatitis C
  • Osteoporosis

Care management programs for members and physicians include:

  • Asthma
  • Cardiovascular disease
  • Diabetes
  • Gastrointestinal disorders

In addition, physicians may take advantage of care management for congestive heart failure, as well as case-specific interventions involving consultations with specially trained nurses and pharmacists.

Welcome, Allen Beverages Inc.!
SAS would like to Welcome this new group to the SAS Family.
 
Members, You can now View Your Claims Online!
SAS Members can now view and print their Claim EOBs (Explanation of Benefits)

Log into your Health Ensure Member Account today to see this new feature for SAS members. Your EOB is available for claims that have completed processing. Just click on the “View EOB” link next to the Claim ID number.