+1 305.692.9009 info@wmmsolutions.com

SERVICES

“An ounce of prevention is worth a pound of cure.”
Benjamin Franklin

SERVICES

What makes World Medical Management Solutions unique?

There are no gimmicks and no false promises. We offer unparalleled expertise and transparency. WMMS is a licensed TPA with an exclusive relationship with World Medical Care, a healthcare provider that operates urgent care clinics and a network of board certified house call doctors. We guide you through the U.S. healthcare system, providing you with timely information in a way that no one else can. This expertise results in soft and hard savings and patient satisfaction that give our payers a winning edge in managing the cost of high quality, U.S. healthcare.

Cost and care prevention.

World Medical Management Solutions was founded with the understanding that true cost containment begins with cost prevention. We can help you achieve significant savings at any point in an episode of care, including after-the-fact. But when we are proactive, managing a case from the onset, we provide payers with a combination of soft and hard savings that our clients tell us are hard to beat.

HEALTHCARE SERVICES & COST CONTAINMENT SERVICES:

Urgent Care Clinics and At-Home Doctor Visits enable payers to avoid hospitalizations in 95 – 97% of cases.

Access to urgent and medical care clinics across the U.S.

Our state-of-the-art clinics are located in key population centers across the country. They provide high-priority, individual medical attention in a comfortable setting. Prices for each service are prominently displayed in patient waiting rooms for a wide range of services, including:

• Blood work, including full blood analyses
• Check-ups
• Diagnostic & extensive laboratory services
• Electrocardiograms (EKG’s)
• Injections
• Employer physicals
• Pre-operative evaluations

• Immigration medical exams by a civil surgeon approved by the Bureau      of Citizenship and Immigration Services
• In-house pharmaceutical services
• School physicals
• Vaccinations
• Vehicle and personal accident-related injury care
• Weight loss programs, including personalized meal plans

Claims Administration

We adjudicate claims on a payer’s behalf at any point in an episode of care that is convenient for you. We can receive claims directly from the provider, or payers can send them to us after-the-fact. For after-the-fact adjudication, just send us what your insureds sent to you. Our medical department will review each episode of care directly with the provider(s) to gather the necessary medical information and coding in order to (a) ensure that the claim is clean and (b) ensure the reasonability of charges. This is how we identify soft savings. We can deny charges for care that doesn’t follow U.S. protocols and for which there is no medical necessity.

Claims Repricing  

Once the claim is clean, we negotiate hard savings on the payer’s behalf, using Medicare rates as our benchmark.

Medical Case Management

When we manage an entire episode of care, we are able to maximize results for payers and their insureds. We start by providing convenient care alternatives (see urgent care clinics and concierge healthcare services) to insureds that help avoid medical situations from escalation to hospitalization in 95 – 97% of cases.

When hospitalization is required, we direct insureds to in-network facilities that optimize the best outcomes (e.g. the highest survivor rates and the lowest infection and mortality rates) and cost, ensuring the best possible patient treatment at a fair price.

Provider Network

Our PPO network provides our clients and their insureds with access to more than 5,000 hospitals, over 90,000 ancillary facilities, and over 1 million healthcare professional service locations in the United States, including Puerto Rico. 98% of the U.S. population is within 10 miles of a participating network physician and within 20 miles of a participating network hospital.

Concierge healthcare services

Are available 24/7 in key population centers throughout the U.S. World Medical Care’s board certified doctors will come to the insureds home, hotel or place of work. To aid in a fast recovery, these doctors are able to provide on-site medications, IV fluid hydration, sutures and stitches. They are equipped with advanced technologies to provide instant results, including lab tests, x-rays and ultrasounds. For employer groups, we can arrange immigration medical exams at low cost by a certified civil surgeon approved by the Bureau of Citizenship and Immigration Services (USCIS) at the insured’s office or home, with rapid processing.

Translation Services

Are available 24/7/365 to facilitate client, patient and family communication during and after an episode of care.
We offer translation in the following languages:

  • English
  • Spanish
  • French
  • Creole
  • Russian
  • Portuguese
FOR MORE INFORMATION OR ASSISTANCE, CALL US 24/7 AT (305) 692-9009
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