CareCore National and MedSolutions, two leading providers of Specialty Benefits Management (SBM) services who contract with private insurance companies to manage their healthcare costs, have merged. At the current time, the new company is continuing to operate under both the CareCore and MedSolutions brands.
Utilizing evidence-based protocols, the consolidated Radiology Benefit Manager’s (RBM) objective is to ensure “the right evidence-based care is delivered at the right time to the right patient at the right site of care.” Managing the skyrocketing healthcare costs is a growing issue that needs attention, but the mixed results in controlling medical costs have attracted controversy and concerns about whether RBMs are helping or hindering the process.
Although the new company has not formally announced or implemented any modifications to current clinical criteria, there have been providers who are already reporting an increase in peer-to-peer reviews and denials for approvals when the office performing the scan is not an approved specialty.
The merger of CareCore National and MedSolutions has resulted in now only four RBMs managing access to care for 85% of all lives subject to review.