Prisons and jails must provide access to medically necessary specialty services that are beyond the scope of on-site providers. Managing all aspects of off-site service procurement and payment is challenging and many correctional facilities use outmoded or inefficient tools and strategies. This session will explore the elements of a modernized system of managing off-site provider and facility services including options for establishing a favorable provider network and reasonable reimbursement rates; efficient claims adjudication, payment and monitoring; and mining claims data to manage population health and on-site provider performance.

Educational objectives

Identify at least two options for establishing networks for off-site specialty and facility care

State three risks of using in-house personnel to manage claims payment

List at least three reports from off-site claims that can inform your facility's population health management and/or on-site provider performance

Level: Intermediate