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Utilization Management Services

Utilization Management Services

Utilization Management Services

By Change Healthcare

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Overview


Select which hospital or health system you work at and see a personalized match score.
About

DESCRIPTION
Select the Right Care Setting to Optimize Reimbursement -- Our Prospective Reviews Help Align Care Needs With Reimbursement Requirements
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PRODUCT ATTRIBUTES
badge_covid-19

COVID-19


badge_pediatric

Pediatric


CATEGORIES

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KEYWORDS

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CLIENTS OVERVIEW
Key Clients
Clients Your Size
USED BY
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1 Organization
EHR integration

Integrations:

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EMR Integration & Relevant Hardware:

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EMRs Supported:

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Hardware Compatibility:

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Description

One of the first, most important decisions your staff can make occurs early in the patient assessment process: Should care be provided at the observation or inpatient level? This “fork in the road” decision can have significant consequences, as incorrect choices can lead to misuse of limited resources and costly denials. Unfortunately, recruiting knowledgeable, experienced staff to guide these decisions can be a challenge. Utilization Management Services help to ensure patients receive the most appropriate level of care while helping to reduce medical necessity denials. Our expert staff provides initial/prospective reviews on admission to determine the appropriate care setting. These include: • Placement-status reviews using InterQual or another evidenced-based, clinical decision-making tool • Concurrent authorization services for admissions • Additional scrutiny when decision-support tools conflict with a physician’s clinical judgement, with additional documentation for medical necessity of care We function as an extension of your Case Management or Utilization Review department, working in your unique environment and using your technologies and tools. Our remote support allows your onsite staff to expand the number of cases you review and to focus on length of stay and highly complex cases that need specific clinical expertise. Business Insights Drive Continuous Improvement: We use reporting and analytics to keep you informed of performance so you can track the return on investment. Our reports include: • Trending on Level of Care denials • Percentage of daily reviews completed concurrently at the time of admission • Percentage of accounts requiring authorization completed • QA scores that reflect how accurately your nursing staff is applying decision-support technology and how consistently they are documenting it in your system • Percentage of clinical submissions that meet payer and timing requirements versus those that miss filing deadlines and are returned as concurrent denials A Flexible Resource: You can 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 to build a strong internal prospective review program.
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Use cases

Description

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Differentiators

Differentiators vs EHR Functionality:

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Differentiators vs Competitors:

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Company information

Founded in 2007

48.0M total equity funding

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