Care Management – Service Details

Wellcove by CHCS Services utilizes advanced clinical tools and treatment protocols for ideal health status outcomes. These solutions support a high level of integration between clinicians and the risk management team. Our care management services help educate your members to make informed healthcare decisions and to balance ancillary services, which can result in a reduction of policy exposure.

Benefit Determination

The Wellcove care coordinator completes an independent assessment in the client’s home or facility in order to expedite and verify benefit eligibility.  The client’s health condition, ADL loss, and cognitive status are evaluated and a personalized plan of care is recommended. The nurse will identify available community resources and Medicare services if needed when developing the plan of action.

Care Plan Development

The Wellcove plan of care process focuses on ensuring the delivery of appropriate care in the most cost-effective manner.  Information from the benefit eligibility assessment combined with additional information from physicians, providers and client support systems are incorporated in the care plan.

The Wellcove plan of care summarizes the service recommendations (including informal support system when appropriate), the purpose of each service recommendation, available Medicare services, additional community resources, proposed frequency and duration of services, cost of services, payment sources and identification of all medical equipment necessary in the delivery of care.

Information and Referral Services

Wellcove provides comprehensive information and referral services through elder care specialists. Our specialist’s help members make informed decisions about:

  • Care options
  • Assistance with locating nursing homes, assisted living facilities, home health care options, retirement communities and adult day care centers anywhere in the nation
  • Identification and referrals to other local community-based resources

Provider Services

Wellcove maintains a nationwide provider database. Our analytics prove that hard savings are realized when care services are arranged to preserve benefit dollars and reduce out of pocket exposure. This is accomplished by establishing provider relationships and negotiating rates with numerous health care delivery organizations.

Nationwide Provider services are available as:

  • Part of care management core services
  • Access incorporated into claims adjudication model

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