Blog
What’s Happening Downstream? Creating Data-driven Utilization Review
Ensuring successful Utilization Review within a hospital or hospital system is a multi-pronged approach. In order to produce impactful results, leaders must empower their teams to continuously innovate and iterate. […] Blog
Denials Management: Doing Denials Differently
Putting the patient first is the common thread between the providers who care for them and the organizations who serve those providers. The denial of patient claims is an ever-present […] Blog
Reframing the Payer-Provider Relationship
It’s safe to say that the provider and payer relationship can be contentious at times, often due to the subjectivity involved in the utilization review (UR) process. But what if […] Blog
Population Health: Adding Up Value in Healthcare
Value-based care, population health and social determinants of health (SDoH) are terms that seem to pop up everywhere for those who work in healthcare. But they aren’t just buzzwords or […] Blog
New Year, Renewed Knack for Medical Necessity
Utilization review was first introduced during the 1960s as a solution to combat the rising costs of healthcare by reducing overuse of resources and identifying waste. Health plans began reviewing […] Blog