Utilization Management

Right care. Right place. Right price.

Utilization Management

Right care. Right place. Right price.

Utilization Management
urac Accredited

With URAC accreditation for Health Utilization Management (UM), MedReview provides payors with an assortment of solutions to ensure members receive the highest quality care, while avoiding unnecessary testing, procedures, therapies and costs.

Our UM solutions focus on reviewing the medical necessity and appropriateness of ambulatory and inpatient hospital services before they are rendered (prior authorization) and during a patient’s hospital stay (concurrent review). To ensure an accurate determination, MedReview obtains all relevant clinical information from the physician and evaluates it against nationally recognized, evidence-based utilization criteria and health plan allowances.

The program also identifies complex or catastrophic cases (e.g., multiple sclerosis, cancer, severe burns and spinal cord injuries) for the potential implementation of our case management program, which is designed to provide an alternative plan of action when the traditional healthcare delivery system is unable to react effectively.

Our Utilization Management services:

Prior
Authorization

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Inpatient Prior Authorization and Concurrent Review

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Case
Management

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