Significantly Reduce The Cost Of Utilization Review -- While Improving Timeliness, Efficiency and Effectiveness

In California alone, spending on workers’ compensation medical cost-containment services increased almost $100 million in just one year; from $187 million in 2007 to $284 million in 2008.

A large portion of that spending was on Medical Utilization Review (UR).  While an effective cost-control strategy that attacks one of the key drivers in medical costs (over-utilization), the process is cumbersome, labor-intensive and entails a significant amount of waste.  For example, only about 20% of all requests result in a denial, modification or delay; 80% of all requests typically get approved.  The requests that are approved simply consume resources and, outside of a watchdog effect, provide no real benefit to the system. 

Smart-UR engages a technology that quickly and effectively eliminates the waste in the system.  Smart-UR makes UR affordable while not interfering with the integrity of the process. 

Smart-UR incorporates the current request with a claimant’s medical history as well as the severity of the medical issue within its targeting algorithms. Requests that are identified as reasonable and necessary are immediately approved and all the appropriate communications and audit requirements are processed. The remaining requests are immediately send on to the payer’s UR/medical review team.  Smart-UR does not require any changes in existing vendor relationships.

Smart-UR is a sophisticated web-based tool that elegantly integrates within any work-flow to optimize a client’s management resources.

See Smart-UR in Action!
Monday, December 7, 2009
See how quickly and simply Smart-UR can cut your UR workload. This demo assumes the basic claim data has been entered and the client is using the Smart-UR web-based platform. In this brief demo, the...