American Specialty Health Networks Recognizes Select Providers for Optimal Performance.

Business Editors/Health/Medical Writers

SAN DIEGO--(BUSINESS WIRE)--April 20, 2004

American Specialty Health Networks (ASH Networks), a subsidiary of American Specialty Health Inc. (ASH), announced a new initiative to identify and recognize providers who demonstrate clinically efficient, evidence-based chiropractic care. Effective Jan. 1, 2004, this innovative program reduces or eliminates the requirement for participating chiropractors to submit treatment plans for chiropractic services.

Many of the health plans or payers contracting with an ASH affiliate require the use of a utilization review program to demonstrate the clinical and medical necessity of services provided to covered members. Thus, ASH affiliates utilize a patient care management program wherein participating providers demonstrate clinical necessity of services through the documentation of the patient's clinical findings on treatment plans. ASH affiliates also employ licensed chiropractors who verify clinical necessity through a peer-to-peer evaluation of the clinical findings described on the treatment form.

The Treatment Form Waiver Program integrates both transactional clinical review-based utilization management program components with clinical provider quality performance components. This affords an appropriate level of clinical review oversight on a provider-specific basis. Providers qualify for various levels of review (one of six different tiers) based upon quality management indices and compliance with ASH standards and administrative protocols. For some qualifying chiropractors, the treatment form submission process will be waived entirely.

"Our treatment form waiver program is a result of four years of evaluation and pilot programs. Early utilization review programs need to evolve into quality and patient care systems that reward and recognize exceptional performance by contracted providers," said George DeVries, chairman, president, and chief executive officer of ASH. "We hope to initiate similar programs with other provider groups in the near future."

ASH Networks is a subsidiary of American Specialty Health Inc. (ASH). Through its subsidiaries, ASH provides complementary health care benefit, affinity network, and health education programs nationwide to health plans, insurance carriers, employer groups, and trust funds. ASH Networks' affiliate American Specialty Health Plans of California Inc. operates in California and is the nation's first and largest health plan for chiropractic and acupuncture. Another affiliate, American Specialty Health Insurance Company, is an insurance company admitted in 41 states.

ASH Networks has been awarded full accreditation by URAC for its chiropractic, acupuncture, massage therapy, dietetics, and naturopathy programs. Recently it received accreditation in the following areas: claims processing, health Web site, HIPAA privacy and security. Based in San Diego with more than 500 employees, ASH and its subsidiaries cover more than 9 million members in benefit programs nationwide.