Direct Medical Management, Inc. (DMM) is a member of The Chandler Group of Companies. In 1982, The Chandler Group was the first managed care company in the state of Ohio to introduce pre-certification as a means to help control health care costs through in-depth medical review. In 1997, DMM became the newest member company and officially assumed all medical review responsibilities for The Chandler Group of Companies.
In 1997, Direct Medical Management was awarded full accreditation by the American Accreditation HealthCare Commission/URAC in the performance of Health Utilization Management.
Our client base consists of the following types of organizations:
• Third Party Administrators
• Insurance Companies
• Taft-Hartley Funds
• Health & Welfare Funds
• School Districts
• Multiple Employer Groups
• Self-Insured Employers
DMM provides utilization management and case management on a national basis.
DMM’s primary review service offered to its clients is utilization management. Utilization management consists of the following services:
· Pre-Admission Certification
· Length of Stay Determination
· Concurrent Review
· Retrospective Review
· Discharge Planning
· Case Management Identification
· Home Health Care
· Outpatient Treatment Determination
· Coordination with PPOs
DMM’s high dollar care management for both chronic and catastrophic illnesses and injuries consist of:
· Large Case Management
· Wellness and Disease Management
· Transplant Coordination and Referral
Medical Review Criteria
As a basis for its medical determinations, DMM subscribes to InterQual’s Clinical Decision Support Criteria.
Utilization management and nurse help line fees are negotiated on a per employee per month (PEPM) basis. Other medical review services such as; Case Management, Appeals Review, Independent Medical Review, Disease Management and Risk Assessment are performed on a contracted hourly basis.
DMM keeps their clients informed regarding utilization management activity through customized reports. These reports can be generated on a daily, weekly, monthly and/or quarterly basis to assist clients in monitoring their medical costs.
DMM’s core group of medical professionals consist of registered nurses supported by a board certified medical director. Adding to our review continuum is a peer review committee comprised of board certified physicians representing every medical specialty.
Products and Services
· Utilization Management
· Case Management
· 24 Hour Nurse Help Line
· Appeals Review
· Independent Medical Review
· Disease Management
· Risk Assessment
Administrative and clinical staff can be reached by calling 800.345.6700 between 8:30 am – 5:00 pm Eastern Standard Time.