Solutions

Treatment

Opus360 Treatment solutions include Case Management, Medical Peer Review & Second Opinion as well as Nurse Consultation Services.

The Opus360 Treatment solutions proactively ensure you and your members have convenient access to a variety of trustworthy professionals, so you can make the best decisions for each case.

Behavioral / Mental Health

Our team’s deep understanding Behavioral Health ensures your patients are treated with compassion and dignity:

  • High levels of education in addition to industry-recognized specialized certifications
  • Services are also sub-specialized within the team  to provide high impact clinical expertise for your members
  • When indicated, access board-certified specialists actively practicing in the indicated behavioral health field
  • COVID-19 educational/inquiry services

Specialized Case Management

Case Management can be challenging. Hines proudly offers one of the most comprehensive services on the market:

  • Pro-actively working with patients, their families, and their physicians, to coordinate the delivery of cost-effective quality care
  • Can be bundled with Hine’s UM services or implemented as a standalone solution
  • Specialty Complex Case Management, including oncology, transplant, renal/dialysis, high risk obstetrics, neonatal, and behavioral health
  • Chronic Condition Management including, Hepatitis C, Crohn’s, Hemophilia, MS and other large dollar or complex diagnoses
  • Specialty Pharmacy Management
  • Transplant Management
  • Upfront Negotiations

Nurse Consultation Services

Hines’ Nurse Consultation Services provide you with professional evaluation for both medical and cost-related issues:

  • Review of claims or requests for medically necessary services or cost effectiveness, as requested by payer
  • When requested, onsite evaluations

Upfront Negotiations

To ensure the right terms are established early on for each case, our seasoned team of dedicated negotiators are involved upfront, allowing you to focus on your members’ needs:

  • Skilled team of 40 professional full-time negotiators
  • Early involvement during treatment to establish case specific payment terms