Medical Management
The Health Plan's Medical Management department is responsible for authorizing health care services for members. Decisions are made based on the member's benefit coverage, nationally recognized guidelines, internal Health Plan policies and medical necessity criteria. For more information, you can contact the Medical Management department at (800) 544-3907, seven days a week from 8 a.m. to 5 p.m.
Medication Management Therapy Program
Geisinger Health Plan offers a Medication Management Therapy Program for applicable Gold members with Medicare prescription drug coverage. This educational program will focus on managing some key disease states, including hypertension, diabetes, congestive heart failure and dyslipidemia, and more specifically the medications used to treat these disease states.
Our goal is to assist Gold members with their sometimes complex medication regimens.Focus areas include correct usage of medications, avoiding interactions between multiple drugs and between drugs and certain conditions, nutrition and dietary supplements, and overall standard of care.
If you have any questions about this program, please contact the Pharmacy Department at (800) 988-4861 between 8:30 a.m. and 5 p.m., seven days a week; TTY/TDD (800) 447-2833 between 8 a.m. and 4:30 p.m., seven days a week.
Quality Improvement
The Health Plan’s Quality Improvement (QI) Department is dedicated to the quality of care provided to our members. Staff members work diligently to oversee preventive health programs and to educate members about staying healthy.
The QI department also collaborates with Health Plan providers in the areas of service improvement and member concerns.
Workgroups comprised of Health Plan physicians, nurses and support staff meet regularly to analyze data and devise initiatives to improve performance on specific health and member satisfaction measures.
