NAVIQFIRM

Owner

Goods & Services

Stop-loss insurance underwriting services for self-funded employer health benefit plans incorporating mandatory care coordination program requirements; Development and management of carrier-integrated managed care programs for self-funded employer health benefit plans, namely, structuring program terms, employer participation agreements, vendor requirements, and benefit plan frameworks under a mandatory care coordination model; Organizing and managing access to high-performance provider networks for self-funded health benefit plans operating under mandatory pre-authorization requirements.

Managed care program design and oversight for self-funded employer health benefit plans, namely, developing mandatory pre-authorization and care coordination frameworks directing members toward value-based care arrangements prior to the delivery of non-emergency medical services; Healthcare program management services for self-funded health benefit plans, namely, designing and overseeing coordination of medical, behavioral health, and specialty care through structured care navigation pathways and developing program documentation for managed care programs; Healthcare navigation program development for self-funded health benefit plan members, namely, designing systems that direct members to high-performance provider networks and value-based care arrangements prior to the delivery of non-emergency medical services, with reduced benefits applicable for non-compliance with mandatory pre-authorization requirements.