Healthcare access & patient navigation
You manage the plan. We help manage the care.
Healthcare access, patient navigation and specialty-care support for TPAs and self-funded health plans.
When a member needs care, NeuMed Direct helps get them to the right place quickly. From immediate evaluation and specialist identification to negotiated physician and facility pricing, scheduling and ongoing patient support, NeuMed Direct helps simplify the healthcare journey from inquiry through completion.
- Immediate Access
- Specialty Navigation
- Negotiated Rates
- Case Coordination
- Patient Advocacy
The NeuMed Direct difference
Four things we do for every case.
Access
Get the member to care. Coordinate urgent or appropriate clinical evaluation when needed.
Navigation
Identify appropriate physicians, specialists and facilities based on clinical need and location.
Negotiation
Work directly with physicians and facilities to establish competitive rates before services whenever possible.
Advocacy
Give the member a dedicated person who helps explain appointments, providers and next steps.
Access + Navigation + Negotiation + Advocacy
How a case moves
How a case moves through NeuMed Direct.
One case. One process. One team helping move it forward — from the first inquiry through billing and reconciliation.
- 1
Inquiry
Case referred by a TPA, employer, Direct Care Plan or authorized referral source.
- 2
Immediate Evaluation if Needed
We coordinate an urgent care or appropriate immediate evaluation when clinically appropriate.
- 3
Case Intake
Member information and clinical needs are reviewed.
- 4
Specialist / Facility Identification
We identify an appropriate physician and care setting.
- 5
Consultation
Member meets with the provider.
- 6
Clinical Information
Provider sends consultation notes, recommended treatment and applicable CPT codes.
- 7
Rate Negotiation
We negotiate rates with the physician and facility.
- 8
Quote Submitted
We provide the referral source with a clear case quote.
- 9
Approval
TPA / employer / plan approves the case.
- 10
Scheduling
We coordinate the procedure or treatment.
- 11
Care Completed
Care is delivered and the case moves into billing/reconciliation.
- 12
Billing & Payment
We complete the financial workflow and close the case.
For TPAs
An extension of your team.
NeuMed Direct is not designed to replace the TPA. We provide an additional healthcare resource that TPAs can use when members need assistance accessing, navigating or coordinating medical care.
Rapid Access
Coordinate timely clinical evaluation when a member needs to be seen.
Specialty Provider Identification
Identify appropriate specialists based on clinical need and location.
Provider & Facility Negotiation
Work directly with providers and facilities to establish competitive rates.
Case Coordination
Keep every step moving — scheduling, documentation and follow-through.
Member Support
Give the member a dedicated person to call throughout their care.
Case Visibility
Share clear case status so partners can see progress without chasing updates.
No competing with your TPA. No replacing your plan. Just another resource when your member needs help.
The patient experience
Behind every case is a person.
Healthcare can be confusing and overwhelming, especially when a member is dealing with a new diagnosis, surgery or serious medical condition. NeuMed Direct gives the member someone to call.
We do not just manage referrals. We help take care of members.
The questions a member is really asking
- Where should I go?
- Who is my doctor?
- When is my appointment?
- Where will my procedure take place?
- Has my treatment been approved?
- What happens next?
- Who do I call if something changes?
Real-time case visibility
Know where every case stands.
Referral partners can understand what is happening without repeatedly chasing updates.
| Case | Status | Provider | Quote | Next Action |
|---|---|---|---|---|
| Orthopedic | Consultation Complete | Identified | Negotiating | Quote Pending |
| Oncology | Scheduled | Confirmed | Approved | Treatment |
| Cardiac | Evaluation | Reviewing | Pending | Specialist Referral |
Orthopedic
- Status
- Consultation Complete
- Provider
- Identified
- Quote
- Negotiating
- Next Action
- Quote Pending
Oncology
- Status
- Scheduled
- Provider
- Confirmed
- Quote
- Approved
- Next Action
- Treatment
Cardiac
- Status
- Evaluation
- Provider
- Reviewing
- Quote
- Pending
- Next Action
- Specialist Referral
When to refer
When should you send us a case?
- Member needs an immediate evaluation
- Member does not know where to receive care
- A specialist needs to be identified
- A surgical procedure is being considered
- Facility pricing needs to be evaluated
- Existing network pricing is unusually high
- Oncology care requires coordination
- A member is having difficulty getting scheduled
- A second provider/facility option is needed
- A direct negotiated rate may create savings
- A complex case requires additional navigation
- The patient needs someone to help manage the process