Our member health is the most important to us. Only qualified medical expertise will engage in the treatment of patients, authorize treatment, refer patients for treatment and deny treatment when medically unnecessary.
Our Chief Medical Officer chairs the Quality committee; and is not a member of any financial committee. Chief Medical Officer reports quality assurance oversight directly to the governing board.
Clever Care is highly committed to provide the healthcare needs of our members. We never compensates or provides incentives to practitioners or any individuals for conducting utilization review for denials of coverage or services. Utilization decisions are made solely on medical appropriateness of care and services under the supervising of Chief Medical Officer.
Clever Care will not award any type of incentive to any individuals or entities for conducting utilization review decisions that may result in under utilization.
All employees shall not derive any personal profit or gain, directly or indirectly, by reason of his or her participation in the decision-making activities relative to their role in the organization.
Clever Care protects its integrity as government contractor. Our Compliance and Audit department report directly to the governing board - independent from operational management.
Clever Care deploys 3 lines of defense to manage its risk:
Clever Care promotes healthy living and preventive medicine to our members.
Our members are Stars, and deserved a Star health plan.
Disclaimer: Every year, Medicare evaluates plans based on a 5-star rating system.
We believe in accurate and actionable data. We will collaborate with our provider partners to capture accurate health data that enable accurate personalized treatment plan that works.