Utilization Review (UR) is a process for
determining appropriate levels of care, while also monitoring the quality of provider services and their ‘match’ with accepted treatment practices. The goal of UR is to promote placement in the least restrictive, least resource-intensive level of effective care necessary to meet the individual’s needs. When that goal is accomplished, oversight agencies control costs while also effectively advocating for members by matching them with the most appropriate services.
We conduct UR for all programs serving a variety of populations, age groups, and diagnoses. Our customized electronic screening tool,
URSA, enables around-the-clock, data-driven utilization review
When utilization review solutions are effective, oversight agencies control cost while also effectively advocating for members.
decisions which offers a substantial cost savings and efficiency measure for states and providers. URSA is customized to accommodate unique participation criteria, provider standards, and other measures important to oversight agencies.