TrustCare Advantage is a set of medical management services that helps employers and employees better manage their health plan benefits and completes a comprehensive healthcare package. These services also help ensure members receive appropriate care, while keeping claim costs in check. TrustCare Advantage services are standard with all Trustmark Group Select Plans.

The Trustmark Group Select Care Management program is a comprehensive service to help control medical costs. It works by reviewing healthcare treatment plans at critical points in the treatment process, including appropriate hospital admissions and lengths of stay.

The care management program requires pre-certification for all inpatient admissions to make sure each member receives appropriate care. Pre-certification is also required for acute and sub-acute rehabilitation, skilled nursing facilities, behavioral health residential treatments, hospice and home healthcare services.

A specially trained medical management team evaluates both the proposed course of treatment and the patient's individual needs. All evaluations are conducted by healthcare professionals and are based on national medically accepted guidelines. Proposed admissions are reviewed for medical necessity and length of hospital stays. Most cases are certified for treatment within several minutes. If a treatment plan varies significantly from established medically accepted guidelines, the case is referred to a second level of review by a specialist. A decision on certification in these cases is typically made within 72 hours. This pre-certification process reduces the need for costly second surgical opinion programs.

Emergency Admissions must be communicated within 48 hours or the next business day. If pre-certification is not obtained when it's required, the member must pay $300 per incident.

Trustmark has teamed with Matria Healthcare, the largest independent provider of condition management services, to offer a comprehensive range of customizable programs that successfully manage some of the most expensive and debilitating chronic conditions: diabetes, cardiovascular diseases, and respiratory diseases such as asthma. Our objective is to facilitate compassionate and effective care management.

Case Management is a patient-centered process that coordinates and monitors major health services by intervening soon after the onset of a serious illness or medical problem. Case managers coordinate complex treatments in difficult situations such as premature birth or an organ transplant, always keeping the patient's wishes and needs at the forefront.

By collaborating with patients and their medical team, full-time nurses serve as case managers and work closely with the patient, physician and family to coordinate appropriate, cost-effective care in concert with the patient's wishes from diagnosis to post-discharge. Our goal is to promote the most effective care, the best use of available benefits and to provide cost savings for the member and employer alike.

Trustmark’s Special Investigation Unit, The Sentinel Group, investigates suspected fraud and claim abuse in health, life, dental and disability insurance. Our proactive stance against fraud helps us control premium cost, possibly saving you and your members money.