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Case Management

Meritain Health’s Case Management program is designed to improve the quality of patient care while maximizing cost savings. We provide individuals a better understanding of specialized care needs, access to Centers of Excellence and specialty care facilities, education on alternatives to costly inpatient care, and direction toward in-network discounts. We work with members to educate and help them make choices that contribute to a healthier lifestyle, thus reducing the incidence of complications and future medical costs. The program is URAC-accredited through American Health Holding—Meritain Health’s sister company through Aetna—and includes the following specialties:


  • Maternity/Neonates
  • Medical/Surgical
  • Oncology
  • Psychiatric/Substance Abuse
  • Rehabilitation
  • Specialty Pharmacy
  • Transplant

Our Case Management team targets cases requiring more attention and results in better medical outcomes for members and greater cost savings for our customers. Our criteria and systems are specifically designed to identify catastrophic and complex illnesses, transplants and trauma cases. They also prompt our review specialists to ask questions about seemingly routine, uncomplicated cases that may reveal increased risk. Once high-risk cases are identified, our Case Management team matches the level and method of services to the intensity of the case in the most cost-efficient manner possible.