VOluntry Benefites Magazine Directory :: Capone & Associates

Capone & Associates

Miscellaneous

Capone & Associates

Group Eligibility

unlimited

State Eligibility

all 50 states and international

Product / Services

Group / Individual

Additional Information

Since 1993 Capone & Associates, Inc has been a reliable provider of medical cost containment services to a wide variety of customers. Our offices are located 30 miles west of Philadelphia, PA. We provide service to regional, national and international clients including health insurers, reinsurers, brokers, attorneys, medigap payers, and selected maritime, workers compensation and automobile insurers. We are a Comprehensive Cost Containment Company. Our customers depend on our experienced nurse case managers to manage all types of disease entities from diagnosis to discharge and beyond. Accredited by URAC as a utilization management provider, we continually assess medical treatment and certify or deny medical necessity by individual patient as clinical indicators dictate.

In addition to case management and utilization review services, an increasing variety of clients turn to our capable team to review medical bills and negotiate fee reductions that stand the test of time. We secure provider sign off on the medical bill negotiations we perform. Predictive modeling as it pertains to future medical expenses on individual cases or a block of business is something we do exceedingly well. Our proprietary software, Validate™©, contains a vast data warehouse of fee schedules, billing practices by specific provider as well as treatment patterns and all the modalities involved in treating a specific disease from diagnostics to surgeries and after care needs.. Our customers have reported a high degree of accuracy when comparing future case reserve projections we have prepared to what a specific case ends up costing them. This information is invaluable.
 
PharmaPass is a service that sets us apart from many cost containment companies. For several years we have been expanding our list of high cost drugs that were historically provided in a hospital setting at high cost. We deftly work with providers and families to change administration of selected high tech medicines from hospital to home generating an average savings of over 50% when comparing what home administration of drug costs to hospital charge after the PPO discount was applied! In addition to providing this service we offer license opportunities for customers who wish to coordinate this service themselves.