WIN addresses the current inconsistencies in the delivery of infertility care created by the lack of treatment standards in this niche specialty. Without appropriate care management, the result is often the uncontrolled use of hormonal treatment, which are the leading causes of multiple gestations, high-risk pregnancies and complications associated with low birth-weight infants. WIN closely monitors, interacts with regulatory bodies and customizes its programs to meet the requirements of state and federal mandates and regulations regarding infertility treatments.  

WIN’s Infertility/IVF Care Management Program focuses on the total infertility dollar associated with this costly benefit compared to other local and/or national programs that focus on pharmacy costs only. This global approach provides substantial savings in infertility costs as well as other related expenses such as high-risk obstetric and neonatal care as a result of multiple births.

WIN’s care management program is staffed by experienced infertility clinicians who provide intensive, hands-on management. Our Care Managers are seasoned infertility nurses with years of experience in clinical practice. They exclusively manage a small number of infertility cases and serve as the central control point within our program. Responsibilities include prior-authorization; initial triage of each infertility patient; referrals to appropriate specialists; coordination of care with provider based on protocols; continuous review for patient progress and treatment plan revisions; hormone therapy monitoring through customized tracking system; collaboration with PCP’s, OB/GYN’s and Reproductive Endocrinologists; patient education and moderation of expectations; and analysis of key quality indicators of infertility programs. WIN’s Infertility/IVF Medical Management program provides diagnosis-specific case management of infertility treatment based on clinical protocols developed by our Medical Advisory Board of prominent Reproductive Endocrinologists.

WIN processes all claims through its proprietary healthcare benefits system which fully integrates benefits and eligibility, medical history, prior authorizations, medical outcomes and pharmacy benefits management. This enables WIN to employ a uniquely sophisticated reimbursement methodology that aligns quality clinical outcomes with cost effective care. In addition, WIN’s fully automated systems audit 100% of claims and related documents and pay in advance of prompt payment requirements while insuring appropriate tracking, reconciliations and timely reporting.