Services
The Services of AIH and Beacon
AIH contracts directly with employers and other health care consumers as a credentialed network of physicians. Beacon offers employers and
other buyers of health care services an integrated network of physicians, hospitals, and other health care providers that can be accessed through
a single contract. AIH and Beacon continue to develop their regional provider network. For specific health care services that cannot be provided
within Eastern North Carolina, AIH and Beacon are contracting with specialty physicians, hospitals, and other health care providers outside of the
region
Provider network services
Medical management programs
Utilization management system
Patient advocacy program
Health plan offerings
Services
Services we provide
Provider networks are made up of doctors, other healthcare providers
, pharmacies, and facilities who contract with insurance companies to become an “in-network” provider. If you go to a provider who is in your insurance company’s network, you will typically pay less than if you go to an “out-of-network” provider who doesn’t have a contract with your insurance company.
Insurance companies have different networks of healthcare providers for different health plans, so it’s important to check if a provider is in or out of your plan’s network before you receive services.
The Medical Management Program is designed to monitor the appropriateness of all medically necessary and covered services for prior authorization care, concurrent review, and post-service care delivered to WPS customers.
In healthcare, utilization management is the techniques and policies for evaluating the necessity of medical treatments and services on a case-to-case basis.
The purpose of the Patient Advocacy Program is to: (1) prevent rights violations; (2) advocate for the provision of quality of care in a humane environment; and (3) review, investigate and resolve rights complaints or issues.
Employer Health Plan Offerings
AIH and Beacon can work directly with your insurance company, or if your company is self-insured, your third party administrator (“TPA”). AIH
and Beacon offer:
- A regional network of physicians, hospitals, and other health care providers
- Medical management services
- Information reporting capability for health plan management
Beacon can provide employers with additional health plan choices. Through a preferred relationship with several “A” rated Insurance Companies,
Beacon can offer fully insured health plans and administration services for self-insured employers. These products and services are the proprietary
health plan programs marketed and managed by Beacon. Beacon only works with rated “A – Excellent” by the insurance rating agency, A.M. Best,
and have a track record of superior performance as an insurance company and health plan administrator.
The distinguishing feature is that AIH and Beacon are accountable, and actually seek to be measured, as to the accessibility, cost-effectiveness,
and quality of patient care offered directly to employers and other health care consumers. Participating AIH physicians have been selected by
their peers, are credentialed, and agree to negotiated, competitive pricing. Our private label health plans provide employers with health plan
options that are marketed and managed exclusively within the communities of Eastern North Carolina.
