Company achieves NCQA Utilization Management Certification

May 27, 2015, 10:30 ET from Claims Development Management

DORAL, Fla., May 27, 2015 /PRNewswire/ -- Claims Development Management announced today that it was certified by NCQA in Utilization Management. NCQA Utilization Management Certification focuses on consumer protection and improvement in service to customers. Standards recognize that organizations that apply for certification have open access networks, and can improve service quality and utilize customized structures to meet purchasers' needs.

"We are very pleased that our organization has received this important certification from NCQA which will allow us to continue enhancing our service model system wide," said Dr. Jose Pelayo, President of Claims Development Management.  Ron Johnson, CEO of Claims Development Management added, "This certification further confirms  our steadfast commitment to providing high quality utilization management services that helps our clients manage costs while promoting  positive health outcomes for their members and supports the network of health care providers."

The Claims Development Management Utilization Management Program is designed to encourage the appropriate and effective use of best clinical practice guidelines, identify opportunities for improvement, and promote cost-effective specialty management benefit plan designs for the Company's health plan partners, their members and network providers. The program is based on evidence-based information, published guidelines, consensus statements, and standards of medical practice.

"Achieving Utilization Management certification from NCQA demonstrates that Claims Development Management has the systems, processes and personnel in place to conduct utilization management in accordance with the strictest quality standards," said Margaret E. O'Kane, President, NCQA.

About NCQA
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

About Claims Development Management
Claims Development Management monitors and promotes the best care possible to members, assists health plans to effectively operate fiscally, and  ensures that the care being delivered is medically necessary, appropriate and aligned with clinical best practice guidelines. The Company's mission is to assist health plans curb unmanaged healthcare services that can compromise members' health and waste limited resources.  Claims Development Management oversees the Utilization Management Program for Provider Network Solutions. 

About Provider Network Solutions
Provider Network Solutions is Florida Based Specialty Network Management Company that currently oversees dermatology, podiatry and orthopedics services for nearly 600,000 managed care members for some of the largest health plans in the region.  To learn more about Claims Development Management or Provider Network Solutions, please visit our website:

Media Contact
Celia Morales | Director of Corporate Services

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SOURCE Claims Development Management