Utilization Management Services

A revenue integrity service for providers who want to use prospective reviews to select the right care settings for optimized reimbursement.

Align Care Needs With Reimbursement Requirements

Help ensure that patients receive the most appropriate level of care while reducing your risk of medical necessity denials

Conduct placement-status reviews using InterQual® or another evidenced-based, clinical decision-making tool

Implement concurrent authorization services for admissions 

Apply additional scrutiny when decision-support tools conflict with a physician’s clinical judgement, helping ensure additional documentation for medical necessity of care

Expand the number of cases you review, and focus on length of stay and highly complex cases that need specific clinical expertise

Track the ROI by using our reporting and analytics to keep you informed of performance 

Utilization Management in Healthcare

A Flexible Resource Customized to Your Needs

  • Engage our services to augment your existing staff or use our team as a complete solution. 
  • We can also provide a bridge to in-sourcing by educating and training your team, helping you build a strong internal prospective review program. 
  • We track and report on several key performance indicators so you can both assess ROI and drive continuous quality improvement in utilization management.

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