Medical Management

DPCI's Medical Management unit is comprised of four different departments:

• Prior Authorization staff provides authorization for services for our members.
• Concurrent Review nurses monitor our hospitalized members and facilitate discharge plans to help with their recovery.
• Case Management follows our members outside the hospital, coordinating their care so they can remain at home.
• Quality Management promotes access, safety and services to members through Prevention and Wellness, HEDIS®, quality improvement projects, monitors, and NCQA readiness.

Keeping members healthy is very important. That's why Delaware Physicians Care offers covered health services and programs to maintain or improve the health of our members and their families. The services available to Delaware Physicians Care members may depend on age and the state program covering them. Check the

• Member Handbook (English)
• Member Handbook (Spanish)

or call Member Services at 1-866-543-2167 for details.

Search MEDLINEplus for information to help you answer health questions. The information in MEDLINEplus does not replace the health care given by your doctor. If you have special health care needs, you should talk to your doctor. MEDLINEplus is a service of the U.S. NATIONAL LIBRARY OF MEDICINE and the NATIONAL INSTITUTES OF HEALTH. To return to the Delaware Physicians Care Web Site after searching on the MedlinePlus site, close it's page.

AFFIRMATION STATEMENT REGARDING INCENTIVES
Clinical medical necessity determinations are based only on the appropriateness of care and service and the existence of coverage. Delaware Physicians Care, Incorporated does not reward individuals for issuing denials of coverage or provide financial incentives of any kind to individuals to encourage decisions that result in underutilization.