Non-Certification of Medical Necessity If Intracorp determines services are not medically necessary, or are being provided at a level of care inconsistent with the standard form of managed care environments, Intracorp will advise the participant and/or the treating physician that coverage cannot be guaranteed. No benefits will be provided for any service related to an inpatient hospital admission or specified outpatient diagnostic test that is determined by Intracorp (either before or after the admission) to be not medically necessary.
Retrospective Review If Intracorp is not notified of an inpatient admission or outpatient diagnostic test, a retrospective review may be performed. A retrospective review may be performed when Intracorp is contacted after discharge from an inpatient admission or 48 or more hours after a specified outpatient diagnostic test was performed.
Medical Case Management Intracorp may perform medical case management for those participants who have a complicated, catastrophic, or chronic condition. Through medical case management, Intracorp may elect to (but is not required to) extend covered benefits beyond the benefit limitations and/or cover alternative benefits for cost-effective health care services and supplies that are not otherwise covered under the Plan. The decision to provide extended or alternative benefits is made on a case-by-case basis to participants who meet Intracorp criteria.
Smart Steps, a Disease State Management Program Plan participants with certain chronic conditions are enrolled in a disease state management program called Smart Steps, administered by Intracorp. Smart Steps is voluntary, completely confidential, and provided at no cost to participants.
Smart Steps provides help, support, and education
for participants living with:
Cardiac Disease Asthma Chronic Obstructive Pulmonary Disease (COPD) Acid-related Disorders Decubitus Ulcer Inflammatory Bowel Syndrome Irritabable Bowel Syndrome Urinary Incontinence
Diabetes Low Back Pain Hepatitis C Atrial Fibrillation Fibromyalgia Osteoarthritis Osteoporosis