Utilization Management & Review (Pre-Authorization and Peer Review)
Our Utilization Management programs provide professional medical oversight designed to promote optimal medical outcomes through appropriate utilization of medical resources. ACCURATE’s utilization review may be performed before, during, or after the provision of health care services, and includes pre-certification as well as concurrent and retrospective case review, and discharge planning.
This comprehensive approach enables ACCURATE to ensure that patients receive optimal medical care that is medically necessary and delivered in the appropriate setting, while properly managing high cost care and hospitalizations.
ACCURATE has extensive utilization management experience, having reviewed more than 200,000 medical and surgical cases for medical necessity, appropriate level of care, and coding accuracy.
Our Utilization Management programs are:
- Staffed and coordinated by licensed healthcare professionals, including physicians covering the full range of clinical services and settings.
- Designed to focus on the medical appropriateness, requested-setting, level of care and quality of care. Customization is available depending on the client’s needs.
- Available on a 24 hour basis and can be “wrapped around” an existing program for night, weekend and holiday coverage.
- External Peer Review Services are offered to a hospital or managed care organization, whenever there is a potential for a denial of all or part of the requested services. This allows for open communication between the reviewer and the requestor, assuring a complete review process. This involves evaluation of the medical condition as well as health care services by review of medical records only, where no examination of the patient takes place. This review is useful in halting unproductive or unrelated treatment.