Utilization Management

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Utilization Management 2017-06-29T23:18:14+00:00

Overview Facts

  • Live 24/7 Phone Coverage Combined with Web-Based Precertification Requests
    • Custom call scripting and dedicated toll-free lines
    • PPO and Payer channeling for members
    • Onsite Review Option
  • How Does Your Utilization Management Program Compare…
    • Gold standard Interqual Criteria and Truven Health Normative Data
    • Automatic Continued Stay Review reduces pended claims
    • Reviews conducted by Registered Nurses and Onsite Physicians
    • Retrospective review of care that should have been precertified – no charge
    • DOL/ERISA appeals – no charge
  • Real-time Automated Identification of Case, Care and Condition Management
    • One integrated system platform for Utilization Care, Case, Care and Condition Management
  • Customized Review Options
    • Outpatient Surgery
    • High Tech Diagnostic Care
    • Skilled Nursing Care
    • PT/OT/ST
    • Outpatient Mental Health
  • Electronic Data Transfer & Reporting