Utilization Review
Your partners in patient advocacy.
As a behavioral health facility, your primary goal is always to give your patients the best care available, for the longest period of time possible. However, as a business, it is essential that you be reimbursed adequately for those services. That is where utilization review comes in. Our U.R. specialists work closely with your clinicians, keeping the lines of communication open for maximum efficiency and responsiveness. Our mission is to always advocate for your patients and receive the longest length of authorization possible.
Working in Partnership
When it comes to securing the optimum care authorization for your patients, it is essential that the utilization review team and clinical teams work together to gather all pertinent information and ensure that correct procedures are followed. As a boutique behavioral health billing agency, we view all our client relationships as partnerships.
The personalized relationship that we will develop with your admissions team means pre-certification of new patients 7 days a week. This open line of communication is what makes the CA Billing experience exceptional. You’ll never miss out on a potential admit because you couldn’t get authorization we are there to support you so that you can always meet medical necessity. When you partner with CA Billing, you are assigned a dedicated UR Specialist who will:
- Forecast expected authorizations based on a patient’s treatment history
- Stay up-to-date with insurance carriers’ requirements for all levels of care
- Foster and maintain beneficial relationships with all carriers and the care managers who work there
- Handle authorization appeals (exhausting all avenues) to obtain maximum authorization length at the highest levels of care
- Obtain initial recertification when admitting a new patient
- Always maintain a direct line of open and responsive communication with you to answer any questions regarding current or potential patients
Patient Advocates
The last thing that you want is for insurance disputes to get between you and providing your patients with the care they need. As a clinician, you are an advocate for your clients at every turn. Our mission is to be their advocate when it comes to handling their insurance provider so that you don’t have to. Your focus should be on their care. Let us take care of the rest.
Our team of Utilization Review specialists provides:
- Open lines of communication
- Immediate responses to requests
- Full handling of communication with insurers
- Maximum length of authorization
- Optimum level of clinical care
- Documentation review and training
Get In Touch
Talk to our specialist V.O.B team to find out how we can speed up your verification process and optimize your reimbursements.
Efficient Authorization
We fully understand the urgency in receiving authorization quickly for your patients. To that end, our utilization review team maintains clear and open lines of communication with your team to ensure that you are updated at every stage. As soon as your patients receive authorization, our team wastes no time in informing you of the extent of the authorization so that care can begin immediately.
Documentation Review
The most important tool in securing optimum care authorization for your patients is proper documentation. In the busy world of patient care, with so many people potentially involved in documenting the processes used and decisions made, it is easy for things to slip through the cracks. To avoid issues, our utilization team provides documentation review services to ensure that claims are not denied and your patients get the care they deserve.
Training
While our utilization team does everything in its power to protect against denied claims, things can still slip through the cracks. One of the most effective ways to ensure claims are accepted is to correct issues at their source. As your partners in patient advocacy, we also provide training to your clinicians and staff to make them aware of ever changing compliance guidelines and give them the tools to produce effective authorization claims from the ground up.
Optimize Your Billing
Our expert team is ready to create a bespoke billing solution for you.