Medica Administrative Manual > Health Management and Quality Improvement > Care Management
Care Management
Adult Complex Case Management Program: Information on the Adult Complex Case Management Program for members in complex or acute situations.
Advanced Illness Program: Information on Medica’s Advanced Illness Program for members facing life-limiting illness.
Behavioral Health Program: Information on the Medica Behavioral Health (MBH) Program for members who live with a mental illness and or experience emotional and functional disruption due to a life event, recent loss or exposure to trauma.
Benefit Appeals: The appeals process and provider's role.
Disease Management Program: Information on the various Disease Management programs for conditions such as asthma, diabetes, and/or heart disease.
Kidney Care Program: Information on Medica’s Kidney Care Program for members with late-stage chronic kidney disease (CKD) or end-stage renal disease (ESRD).
Pediatric Case Management Program: Case management of infants or children with special needs.
Pregnancy Program: A family-centered model that supports the health of pregnant women and their babies in partnership with the health care provider.
Tobacco Cessation Program: Information on the Tobacco Cessation program for members ready to quit.
Transitions of Care Program: Information on the Transitions of Care (TOC) program for members who are at risk of readmission.
Transplant Case Management: Management of prior authorization requirements for appropriateness of transplant, network status of facility for best member benefit and pre and post transplant services that may be needed by the member.