Utilization Review ServicesBilling sevice

At Lucrative Consulting our Utilization Review Specialists make sure that your clients obtain the coverage they need. Our goal is to obtain the highest level of care for the longest duration possible within insurance guidelines based on medical necessity. From the beginning to the end of a client’s care, you can count on our Licensed or Certified, experienced, and skilled team to advocate for your clients and hold payers accountable to the commitment they made to their members.

 

Utilization review is a way insurance companies monitor their members’ care and manage the appropriateness of medical necessity.  The insurance case manager will make an assessment of medical necessity for the client based on diagnosis, current medical condition, and prognosis. They will also be comparing level of care and duration with average lengths of stay from review to review. Lucrative Consulting has worked with treatment centers to strengthen and enhance their documentation, recording strategies and assessment processes to ensure the most appropriate stay and level of care for individuals in treatment.  We want to guarantee their stay and advocate for clients while you’re meeting their needs and providing quality care.

Lucrative Consulting utilization team boasts the following:

  • Utilization Review by qualified clinicians
  • Reports to track concurrent reviews
  • Skilled clinical staff providing peer to peer support
  • Collateral case management and planning with clinical staff
  • Key understanding of health care processes to ensure longest lengths of stay
  • Single case agreements negotiated

Lucrative Consulting is here to reduce frustrations and increase your ability to help clients in their recovery process.