Surgical Procedures Solution

Bring smarter surgical care to the right place

Our Surgical Procedures Solution helps optimize surgical care for your members and savings for your health plan. We do this by driving a value- and evidence-based approach to high-volume outpatient surgical procedures through timely and effective provider engagement.

Lines of business

•  Commercial
•  Medicare
•  Medicaid
•  Federal employee

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What if the entire surgical care experience worked better?

Along the surgical procedures care journey lie many opportunities. There are chances to remove the barriers between your members and important surgical care, to transform their experience into easier, more-modern ones, and to drive meaningful savings for your business. Our solution helps realize them, and more.

Make surgical care more accessible and affordable

Our solution helps curb the overuse of hospitals and other high-cost settings when they’re not clinically indicated.


Raise the quality of care — and your savings

We drive value and high-quality, patient-centric care by ensuring the clinical appropriateness of endoscopy and other common surgical procedures.


Create a seamless, connected provider experience

Our automated platform and provider engagement resources help make it easier for your providers to adopt our solution.


Inside our Surgical Procedures Solution

Curbing surgical costs often depends on making sure common procedures are directed to optimal settings. Our solution covers that and more.

Clinical setting optimization

Clinical appropriateness review

Practice engagement resources

Advanced analytics and reporting

Clinical setting optimization
Clinical appropriateness review
Practice engagement resources
Advanced analytics and reporting

How our solution works

Your providers submit requests to us online or over the phone.

Our automated platform reviews requests in real time.

Requests meeting clinical criteria are immediately approved. Our clinical reviewers, including board-certified surgeons and nurses, are available to consult with your providers about any requests that don’t meet our clinical criteria and/or health plan medical policy.

We redirect surgical procedures to high-value sites of care when clinically appropriate.

Request data is shared with your system(s) for claims, care management, and reporting purposes.

Ask us about our Surgical Procedures Solution

Health plan leaders, contact us to learn more about the possibilities and impact of our Surgical Procedures Solution.

Are you a health plan member?

If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card.

Provider inquiries

For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team 

Business hours: 8:00 a.m. – 5:00 p.m. CST.