Cost Containment

Our mission is to be your leading resource for Medical and Legal determinations which will effectively reduce the human and economic losses of injury and disability associated with our clients and examinees.

Case Management

BMEGateway Case Management is provided by highly-trained Registered Nurses and Certified Vocational Counselors who are skilled at handling severe, complex medical conditions. It is their expertise and knowledge of local medical providers, facilities, and community resources that enables them to control costs and quickly achieve successful outcomes.

Our Case Managers provide complete Medical and Vocational services ranging from On-site and Telephonic Case Management to Vocational Counseling and return to work coordination. BMEGateway upholds the industry’s toughest Quality Assurance Standards (QAS) on every Case Management function to ensure consistency in service.

Communication with all involved parties is carried throughout the life of the case so that no plan is implemented until all parties are in agreement. Our ‘Specialized’ Case Management products provide cost-effective measures of determining the level and type of medical or vocational management necessary on files prior to implementation of Case Management. Upon completion of Case Management tasks, our nurses will help coordinate the referral to other BMEGateway services.

   To locate a field case management in your area, please click here.

Utilization Management

BMEGateway can effectively manage the cost and utilization of medical services incurred by injured parties. Our medical professionals assist in the review of inpatient and outpatient procedures through Pre-Certification, Retrospective, Prospective and Concurrent Reviews. We enhance their effectiveness and the savings for customers in several ways. Since our network providers are under contract to receive payment only for medically necessary care, we base our reviews on medical necessity, not just the level of care or length of stay. In addition, all denials are made by BMEGateway Physician Advisors who are board-certified in the appropriate specialty. In conjunction with other BMEGateway Managed Care Services, these programs provide a fully-integrated medical management system.

PDA (Pharmaceutical Diagnostic Analysis)

PDA is a powerful, online investigative tool that can provide you with an individual's medical profile within minutes. Compiled from data electronically retrieved from multiple sources, these profiles convey not only the detailed drug and insurance eligibility information included in an individual's five-year pharmaceutical benefit history, but, more importantly, their treating physicians, predictive diagnoses, and predictive morbidity/mortality costs - precisely the information you need to help you reduce costs, lower loss ratios, and increase revenue. Moreover, BMEGateway's PDA is a fast, secure electronic order and delivery system that allows you to act on these insights without delay.

   Click here for more information about our PDA or to request a PDA.

Nurse Consultation

Our nurses provide a retrospective to present file review of the medical history to help establish a course of action which will bring about claims resolution in the most timely and cost effective manner

   To locate a nurse management in your area, please click here.