Utilization Management

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 Thomson Healthcare 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

Program Impact

• Savings of 0.97 Days per Admission
• ALOS for All Major Diagnostic Categories Below Case Mix Adjusted Normative LOS
• Significant Stop-loss Discounts