Utilization Review ServicesBilling sevice

At Lucrative Consulting our Utilization Review Specialist makes 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 their insurance guidelines for medical necessity. From the begging to the end of a Clients stay in your 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 reviews is a way insurance companies monitor their members/costumers care and manage the appropriateness of medical necessity.  A case manager, representing the insurance company, will make an assessment of medical necessity for the client based on progress, diagnostic criteria and statistical reports.  Diagnostic criteria is a significant focus of case managers during a UR.  They will also be comparing level of care and duration with average lengths of stay for review to review. Lucrative Consulting has worked with treatment centers for decades on strengthen and enhancing their documentation, recording strategies and assessment processes to ensure the most appropriate stay and level of care for individuals in treatment.  We want to expand their stay and advocate for clients while your meeting their needs and providing quality care.

Our licensed and experienced clinical staff can help maximize your Client’s benefits by obtaining maximum stays based on clinical necessity and best practice at the highest levels of care.

  • Utilization Review by qualified clinicians
  • Online live reports to track concurrent reviews.
  • Skilled clinical provides 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.