Utilization Management
We offer expert-level review and clinical analysis of medical records and information to make determinations about the appropriateness and necessity of health care services. Our staff of licensed professionals use our proprietary technology to deliver reliable and defendable decisions to ensure that resources are used judiciously in meeting the needs of patients.
Solutions
Customized and Actionable
We work as a trusted partner to identify and develop the optimal review program for each client, whether prior authorization, concurrent and/or post-payment reviews. Applying evidence-based practice, clinical expertise and established policies, our reviews safeguard against unnecessary, ineffective and inappropriate use of services.
- Prospective
- Concurrent
- Retrospective
- Education
Outcomes
30+
30+ years’ experience
We apply more than three decades of institutional experience to manage utilization and deter overutilization of valuable health care resources.
0
0 overturned decisions
No appealed adverse decisions have been overturned by an Administrative Law Judge since 2015.
738K
738,000 reviews on time
Our experts completed 738,800 review for prior authorization of therapy services for the state of North Carolina over a five-year period with 99.9 percent completed on time.
Outcomes
30+
30+ years’ experience
We apply more than three decades of institutional experience to manage utilization and deter overutilization of valuable health care resources.
0
0 overturned decisions
No appealed adverse decisions have been overturned by an Administrative Law Judge since 2015.
738K
738,000 reviews on time
Our experts completed 738,800 review for prior authorization of therapy services for the state of North Carolina over a five-year period with 99.9 percent completed on time.
Customers
Decades of experience
Our broad experience, knowledge base and agility allow us to adapt our work to best meet the needs of State agencies and others across the spectrum of health care settings.