Capstone PresentationTaylor Gildner

Locations

What is Helios?

3rd party administrator for insurance companies throughout the US

Set up cost containment services including pharmacy benefit management and ancillary services like DME & HH

www.helioscomp.comWorkers’ Comp, AutoMed, UMWA

Ancillary Benefit Management

Catastrophic Care (CAT Team)- care coordination for patients suffering from a severe injury, such as burns, paraplegia, quadriplegia, traumatic brain injuries (TBI), and multiple trauma injuries.

Home Health Care- RN/LPN, PT, OT, HHA, HIT Diagnostic Services- MRI, CT, X-Ray, Ultrasound Language Services- Onsite, Telephonic, & Document

translation Transportation Services- sedan, wheelchair, stretcher,

ambulance Physical Medicine- Outpatient PT/OT Medical Equipment & Supplies- Canes, Crutches,

Wheelchairs, Wound Care dressing, orthotics, etc

Pharmacy Benefit Management

Tmesys, a processing system, is a directly-contracted network that includes virtually all of the nation's retail pharmacies

Home Delivery program for injured worker’s who can’t get to the pharmacy

Goals: managing pharmacy transaction costs and assist with processing prescriptions

Key Points

A lot goes on behind the scenes!

All services are required to be authorized by the insurance company before we can do anything

Documentation and Communication is a must!

Different rules for different states/insurance companies

Every employee is important to make sure the entire company runs smoothly

Questions