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HOW MODERN TECHNOLOGY FIXES TRADITIONAL UR'S PROBLEMS

The Evolution of Utilization Review and Its Impact on Revenue Integrity

Existing utilization review (UR) paradigms are no longer suitable for addressing the changing commercial payer denial landscape and the obligations placed on case managers as a result of value-based reimbursement (VBR). As this whitepaper shows, new processes and technologies that leverage artificial intelligence (AI) can simplify UR efforts and shift case manager attention to improving the quality measures upon which VBR depends.

Learning points include:
  • Using AI for reducing manual initial case stratification
  • Eliminating case referral risk
  • Refocusing staff to higher value tasks
  • Using physician advisors in the most effective way
  • Getting key information quicker and earlier in process

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