What is utilization review?
Utilization Review (UR) is the process insurance companies use to approve, authorize or decline services. The purpose of the Utilization Review process is to screen and approve the "least-restrictive" clinical services on a per case basis. The reason insurance carriers use this process is to standardize approval criteria as well as to prevent fraud, abuse, and waste of unneeded service dollars.
How important is utilization Review to my company?
Any behavioral healthcare organization that works with insurance should realize that Utilization Review is one of the most critical aspects of obtaining payment. Quality Utilization Review and Management is the starting point from which the financial health of a healthcare organization is derived. Often overlooked or disregarded, improper and/or poorly managed UR limits profitability and a client's length of and access to treatment.
How can AVA help me?
In-house training and development
We believe that no one can fight harder for your clients and their families than your own staff. Facility staff have firsthand knowledge of clients clinical cases, ongoing struggles, successes, long term treatment goals and plans, and symptoms that meet medical necessity criteria. Because of this, AVA offers our depth of experience to assist you in in-house hiring, training and/or development of top-notch Utilization Review professionals.
Outsourced Utilization review and management
For facilities that are not able to offer in-house Utilization Review, AVA provides an outsourced solution for an organization's UR needs. AVA sets itself apart from our competition by focusing on communication with facilities intake/admissions team to develop a full medical and clinical picture of the client's case prior to and upon intake. Upon intake, AVA's UR team is able to frame the best argument for each and every client. This level of service and attention to detail is unparalleled. Our trained professionals are available to effectively manage this process for you.