Home | Utilization Management
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Utilization Management
A preapproved claim usually results in claim payment. Therefore, it is imperative that medical professionals demand a quality utilization review decision each time prior approval is sought. Appeal Solutions has extensive information on initiating appeal during utilization review.
Topic Areas for Utilization Management:
Utilization Management Appeals
Effective Utilization Management appeals are vastly important to patients and can greatly reduce unwanted managed care denials. Strengthen your utilization review demands by citing the carrier’s legal responsibilities related to utilization management. . . .more >>
Review and Use of State Utilization Review mandates including Peer Discussion
Utilization review is heavily regulated to insure quality medical decision making. Make a point of demanding compliance with utilization review protections starting with Peer Review Availability. . . .more >>
Health Utilization Management Accreditation Standards
URAC has established health utilization management standards which sets standards for initial clinical review, peer clinical review and appeals. Because many carriers are accredited by URAC, these standards can be cited in many utilization management appeals. . . .more >>
Tracking Preauthorization Response Compliance
Utilization review requests deserve prompt attention. Medical organization must track requests and track payer performance. Noncompliance should always be detailed in related appeals along with supporting documentation. . . .more >>
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