Simplify Healthcare, Outsource with Care.

Plugwork Health utilizes international delivery methods to ​offer tailored clinical solutions on a large scale to hospitals, ​health plans, managed care, life sciences, and absence ​management organizations.
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Impact of the Nursing Shortage Crisis
Hospitals in the U.S. report ​having a nursing vacancy rate higher than 7.5%
0 %
Average
turnover rate
0 %
Average cost of turnover
for a bedside RN
$ 0 K+
Annual cost of turnover
for average hospital
$ 0 M+

Enhance your team with highly skilled remote clinicians

We supply teams of Professional Remote ​Clinicians in various sizes, allowing you to ​prioritize what truly matters.
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Transforming Healthcare
Process Outsourcing

Plugwork Healthcare involves healthcare-focused ​administrative tasks that benefit from clinical ​expertise or require a clinician's involvement. We ​introduced this innovative method to elevate ​traditional Business Process Outsourcing ​standards.
Our clinical proficiency is characterized by a ​commitment to excellence, adaptable live and ​virtual support options, proficiency in intricate ​clinical processes, and adherence to industry ​security and compliance regulations.

Deep Clinical Experience

Cost Savings
Up to 0 %
Nurses & Practitioners
0 +
Clinical Focus
0 %

Expand Your Clinical Team with our Quality Focus Services

Explore our suite of services to solve for your unique needs
Bill Review

Increase precision in the ​adjudication of claims.

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Coding

Saving you time and money

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Utilization Management

Lower the increasing ​healthcare costs.

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Absence & Disability ​Management

Reduce industry pressure on ​claim operations

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CSO Analytics

Ensure precision and eliminate ​data entry errors.

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Collections

Maintain financial health and deliver quality care.

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Estimate Your Cost

Quality Advocate Services do not have to come at a high cost.
MONTHLY COST
PER ADVOCATE $0
4-8 3% Discount
9-15 5% Discount
16-20 8% Discount
21+ 10% Discount
  • TAX Inclusive
  • No Set-Up Fees
  • No long term Contracts
MONTHLY DISCOUNTED PRICE
PER ADVOCATE $0
BILLED MONTHLY $0
INCLUSIONS
  • Staff Wages
  • All Required Staff Contributions / Benefits
  • Desk, Chair, Computers
  • High Speed Internet with Backup
  • Redundant Electricity
  • Standard Software
  • Professional Recruitment
  • HR
  • Staff Payroll
  • 24/7 IT Support
  • 24/7 Physical Security

Long-Term Solution with Care

Partner with Plugwork and Simplify Clinical Processes

Got Queries For Us?

Help us find the answer to your question by entering the details below:

Full-Service Utilization Management Provider

Intake

Receiving the inquiry and assigning a case number for clinical assessment. Fax, Phone, Web.

Physician Review ​Assistance

Assisting physician reviewers for quicker and more precise decisions.

Support After the ​Decision

Informing the requester of approval or denial through letter or phone call.

Medical Assessment

Assessing the request for medical necessity and granting approval if it aligns with the specified criteria.

Appeals and ​Grievances

Assessing member and provider appeals to determine the validity of the denial.

Plugwork’s Deep Utilization Management Capabilities

1
Intake
  • Intake via phone, fax, ​web
  • Clinical case building
  • Appointment ​coordination
2
Summary
  • Office visit notes
  • Clinical scenarios
  • Patient history ​compilation
  • Packaging for next-​level review
  • Peer to peer ​coordination
3
Determination
  • Review request vs. ​MCG, InterQual, CMS ​or client-specific ​guidelines
  • Gathering additional ​information necessary ​for determination
  • Determination of ​appropriateness
4
Post Determination ​Support
  • Determine letters
  • Outbound telephonic ​determination communications
5
Appeals ​& Grievances​
  • Intake
  • Summary
  • Determination
  • Post-Determination ​Support
  • Member & Provider ​Appeals
  • Non-Clinical Appeals

Quality-Driven Services to Achieve
Efficient Absence Management Services

Document Handling

Organizing, inputting, and uploading documents and data to update client profiles, claims, and records.

Provider Verification

Updating client details using medical certificates over the phone.

Eligibility Assistance

Assessing leave requests and eligibility for FMLA and state leaves. Handling and revising claim details from medical certificates received via fax and other channels.

American Disability Act

Managing claims to establish disability accommodation leaves.

Payment for Disability Claims

Supporting disability claims with a focus on providing benefit payments to disabled claimants.

Audits for Performance ​Guarantees

Reviewing onshore procedures

Nurse Disability ​Review

Thorough evaluation of medical records to determine the claimant's capabilities and readiness to return to work.

Management of ​Nursing Cases

Reviewing medical records to assess a claimant's ability to return to work for short-term and long-term disability requests. Offering recommendations to address and handle the claimant's condition or situation.

Achieving High-Quality Results on a Large Scale

1
People
  • Six Sigma Process ​Experts
  • Leading Employee ​Retention Rates
  • Clinical SMEs and ​Account ​Management
  • Over 4,000 clinicians
2
Determination
  • FMLA Pre-Approval
  • Review eligibility for ​leaves
  • Update Client Code ​and Intake
  • Verbal Certification ​Processing
3
Post Determination ​Support
  • Minimized errors
  • Citrix license cost ​savings
  • Increased daily ​coverage and ​improved clearance
  • Full utilization of IPA ​to retain encoded ​information

Full-Service Coding Provider

Risk Adjustment & HCC Coding

Effectively recognizing revenue integrity issues and opportunities

Coding for outpatient services, facility charges, and professional fees

Verifying that codes and modifiers lead to accurate payments across various services, including outpatient facilities, professional fees, clinics, labs & diagnostics, recurring conditions, and complex cases like Obs, SDS, ED, etc

InPatient Coding

Decrease accounts receivable burden by ensuring precise and prompt completion of diagnosis, PCS coding, and DRG assignment.

CDI & Provider Education

Increase revenue by improving documentation quality and precise CPT coding through identifying critical clinical documentation gaps, identifying query opportunities, and educating physician providers.

Home Health Coding

Optimizing Home Health reimbursements under PDGM by ensuring precise coding, conducting OASIS assessments, and reviewing the Plan of Care (POC).

Coding Quality Auditing

Tailored audits help you save time and money, such as DRG audits.

Straightforward Procedure

1
Integration

System integration with our ​secured contact centers

2
Employee Orientation
Procedures implemented ​to guarantee precise and ​effective delivery.
3
Training
Employees undergo ​training on your content ​and achieve certification.
4
Quality
Clear definitions of success ​metrics and remediation ​processes are established.

Billing Analysis Services

Support across all phases of the Billing Review lifecycle
Data Collection

Performing OCR or manual KFI on various types of bills

Cost Revision & Guidelines Application

Thorough examination of coding, repricing, fee schedules, and adjustments based on state laws

Nursing Assessment

Ensuring accuracy of services, adherence to CPT code guidelines, and verifying payments for correct fees

Reassessment

Validating appeals, conducting a second review, and reconsidering PPOs

Straightforward Procedure

1
Integration

System integration with our ​secured contact centers

2
Employee Orientation
Procedures implemented ​to guarantee precise and ​effective delivery.
3
Training
Employees undergo ​training on your content ​and achieve certification.
4
Quality
Clear definitions of success ​metrics and remediation ​processes are established.