Improving Utilization Review Accuracy
As health care shifts to a more proactive management of acute care patients, the pressure to deliver preauthorization and member care decisions faster mounts. And rapidly changing stands of care, emerging treatments and new technologies across hundreds of medical specialties are hard for any healthcare organization to keep up with.
The best practice is to ensure that “like specialists,” who are up to date on the current medical literature, review preauthorization and member care decisions. This practice gives you decisions that benefit both the healthcare plan payer and the patient.
An IRO can provide independent medical reviews by like specialists to help utilization review, utilization management and case managers make preauthorization decisions, across hundreds of medical specialties and sub-specialties. The autonomy and specialist availability of IROs is well-suited for making complex medical necessity determinations. That’s why many utilization management firms lacking a specific specialist expertise turn to IRO for these cases.
AllMed’s utilization review services integrate into your medical management workflow, delivering the shortest turnaround time for your members—and ensuring the perfect match for every case with the right board-certified specialist.
For more information, visit the new Utilization Review web page where you can download a Utilization Guide.