Clinical Solutions is responsible for:
- Establishment of medical policies
- Utilization management policies
- Physician review activities
- Appeals decisions
- Clinical quality improvement
- Wellness program development and support
- Physician subject matter expertise to operations
- Clinical provider outreach activities
- Coordination of accreditation activities, including serving as URAC liaison.
Clinical Solutions also works on developing Blue Cross' activities to measure hospital and physician quality.
This department also supports the development, implementation and maintenance developing, implementing and maintaining operations of two healthcare delivery programs, Blue Health Services (Disease Management program) and Blue Touch (Case Management program).