Choose Our Services & Get Best
We help healthcare providers streamline operations with expert RCM and UM services—from prior auth and billing to eligibility checks and A/R management. Focus on care—we’ll handle the rest.
Utilization Management
What is Utilization Management?
Utilization Management (UM) evaluates the necessity and efficiency of healthcare services to ensure appropriate patient care while controlling costs. Our UM services improve outcomes, optimize resource use, and support regulatory and payer requirements.
Our Services
Prior Authorization
Our team works closely with healthcare providers and payers to streamline prior authorization by evaluating the necessity of treatments, ensuring insurance compliance, and reducing patient care delays.
Discharge Planning
Our team collaborates with care teams from admission to ensure patients have the resources and support for a smooth transition, preventing readmissions and promoting positive outcomes.
Case Management
We coordinate care for patients with complex or chronic conditions, partnering with healthcare providers and payers to ensure appropriate treatment, manage utilization, and reduce unnecessary services.
Appeals and Denials Management
Our team helps review denied claims, gather supporting documentation, and submit appeals to ensure patients get the care they need and providers are fairly compensated.
Concurrent & Retrospective Review
Our concurrent review services monitor ongoing inpatient care to determine the necessity of continued hospitalization, promote timely discharge planning, and prevent unnecessary stays. Retrospective review evaluates care already provided to ensure treatments were appropriate and cost-effective, supporting accurate claims processing and identifying areas for improvement.
Benefits of Utilization Management
By ensuring that treatments are medically necessary and timely, patients receive the care they need without delay.
UM helps eliminate unnecessary services, reduce hospital readmissions, and manage healthcare costs for both providers and payers.
Our UM services ensure adherence to payer policies, clinical guidelines, and regulatory requirements, minimizing the risk of non-compliance.
By managing healthcare resources effectively, we help reduce overuse of services, preventing waste while maintaining high-quality care.
