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First Health Services Corporation

First Health Services Corporation (Services), a subsidiary of First Health (NASDAQ:FHCC), is a health care management and information services company that works exclusively in the public sector. Services works to meet the needs of state Medicaid, pharmacy, pharmaceutical assistance, mental health, long-term care, and other health care programs.

Headquartered in Richmond, VA, Services provides clinically based services that are designed to promote quality care by integrating health care-management programs, innovative technology and cost-effective solutions tailored for each state. Currently, the company provides services to agencies in 32 states, handling more than 200 million claims for more than 20 million consumers.

First Health Services Corp., originally founded in 1968 as The Computer Company, has been a pioneer in the Medicaid and public sector health care industry, developing some of the nation's first computerized Medicaid Management Information Systems (MMIS).

With more than 30 years of experience developing and operating some of the country's largest MMIS medical claims processing systems, Services is uniquely qualified to serve states as their fiscal agent.

As a fiscal agent in three states, Services:

Processes more than 33 million claims for more than 1.3 million eligible recipients each year.

Offers multiple managed care activities, including data capture, claims resolution and payment, imaging document management, electronic data interchange and federal and state reporting as well as managed care enrollment broker services.

Services is a national leader in pharmacy benefit administration (PBA) services for public sector clients, including both Medicaid and state pharmaceutical assistance programs for senior citizens and the disabled. The goal is to improve program and patient outcomes as well as lowering the rate of growth of pharmacy costs by improving drug utilization through expert clinical management and support services. PBA services include:

Clinical care management, including prospective and retrospective drug utilization review, prior authorization, provider profiling and disease state management services as well as the development of preferred drug lists and the negotiation of supplemental rebates with pharmaceutical manufacturers.

POS claims administration of more than 168 million claims for more than 7 million members annually.

Administration of Standard and Supplemental CMS Rebate programs including collection rates above the national average, fast turnaround on cash flow, and efficient dispute resolution.
Effective data analysis and decision support, including the ability to produce immediate reports, determine trends, assess high use/overuse of drugs, establish interventions and track their impact.
Member and provider services, including "Help Desk" availability 24/7/365 staffed by trained technicians or pharmacists able to handle inquiries regarding clinical issues, prior authorization, member eligibility and drug pricing.

Services provides state Medicaid clients with a variety of clinical-based Health Care Management (HCM) services focused on increasing quality and access to appropriate services while helping to ensure integrity of program policy and financial resources, including:

Prior authorization, concurrent and retrospective medical necessity reviews for outpatient, residential and inpatient Medicaid services provided to Medicaid clients of all ages.

Care management and intensified review for high-risk consumers.

On-site provider claims and compliance audits.
Criteria and protocol development for each state by First Health clinical staff to facilitate promotion of national best-practice standards while helping to ensure appropriate adaptation to local practice patterns and available care resources.

First Health Services, through its Centers for Medicare & Medicaid Services (CMS)- certified peer review organization (PRO)-like status, can offer states the ability to receive 75 percent federal financial participation (FFP) reimbursement, instead of the standard 50 percent, for certain utilization management and utilization review services.

  More information can be found on the company website at

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