We have a modern, well-staffed telephonic Utilization Management department. Our Utilization Management team performs the following services:
Pre-certification or pre-authorization
Medical necessity review
Retrospective reviews
Continued stay or concurrent review, and
Discharge planning.
In addition, we provide the following services as a routine part of our utilization management:
Re-direction from non-panel to panel providers, and
Rate negotiations with non-panel providers
What is Utilization management? It is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. Utilization management describes proactive procedures, including discharge planning, concurrent planning, pre-certification and clinical case appeals. It also covers proactive processes, such as concurrent clinical reviews and peer reviews, as well as appeals introduced by the provider, payer or patient.
You may contact our pre-authorization department at:
