Utilization Review

Comprehensive Utilization Review Services

Ascend understands every state’s goals and initiatives to promote placement in the least restrictive, least resource-intensive level of care necessary to meet individuals’ needs. With methods based on these principles, Ascend delivers gold standard, evidence-based Utilization Review (UR) services for a variety of state programs and a diverse range of populations, age groups, and diagnoses.  Our UR methodologies are tailored for each state to accommodate unique participation criteria, provider standards, and other measures important to oversight agencies.  Ascend’s customized electronic screening tool offers a substantial cost savings and efficiency measures for states and providers by enabling around-the-clock, data-driven utilization review decisions.  Using Ascend’s processes and systems, states have fast results in determining support needs and appropriate levels of care, and they have immediate access to monitor the quality of provider services and their treatment practices. 

With our designation as a Quality Improvement Organization-like (QIO-like) Entity by the Centers for Medicare and Medicaid Services, states contracting with Ascend on UR activities receive enhanced federal matching incentives (up to 75%) for qualifying utilization review and quality of care initiatives.

What is UR?

Utilization Review (UR) is a process for determining appropriate levels of care while also monitoring the quality of provider services and their comparison 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.