Through a combination of care coordination, preventive health programs and case management, Concordia assures that its clients’ members have prompt and appropriate access to needed medical, mental health, substance abuse, educational and other services.

  • Availability of a quality credentialed and specialized state-wide Provider Network.
  • Telephonic access to care coordinators and clinicians for members and providers 24 hours a day, 7 days a week, including interpreter and TTY services.
  • A continuum of Care Coordination and Utilization Management Services including Preventive Health Initiatives, Eligibility, Referrals & Authorizations, Complex & Special Needs Case Management and Drug Utilization Review Programs.
  • Reliable and secure technology and Provider web.
  • Timely claims adjudication and processing.
  • Comprehensive and reliable encounter data, utilization and quality reporting to clients and regulatory agencies.
  • Quality monitoring of Provider Network through on-site visits, medical record reviews, access monitoring, annual satisfaction surveys and provider profiling (or scorecards).
  • Quality Improvement and Management, including comprehensive Behavioral Health HEDIS Outcomes Management and STARS Program.
  • Cultural Competency Program.
  • Risk Management and Compliance – Fraud, Waste, and Abuse Program.
  • Denials and Appeals Management.
  • Monitor and coordinate Complaints, Grievances and Compliments.
  • Employee Assistance Program(EAP).