Behavioral Health Utilization Review

Software Designed to Boost Your UR Success

Cumbersome UR processes strain resources. Searching for evidence of medical necessity before a call with an insurance payor stretches the staff. Denials can risk clinically needed patient care. What if software could identify and score key evidence ahead of time, improve UR performance and length of stay, reduce the risk of denials, and provide the metrics you need to improve processes? Behavioral Health CareChain (BHCC) offers a better way!

Utilization Review Task Efficiency: Comparison of task completion time between current UR processes and with Behavioral Health CareChain

Improved UR Performance and Workflow Efficiency

BHCC eliminates manual document searching and fully prepares UR staff for insurance calls. Evidence strength scoring helps ensure that cases needing additional provider input can be handled first. The UR nurse has instant access to summary information through a single screen with links to relevant documents. UR staff enter reviews with confidence, reducing stress and improving retention.

Automation refines the workflow process to increase productivity and efficiency by 10-20x. Improve your reviewer retention and job satisfaction.  

  • Cut down chart review time.
  • Eliminate the need to manually search for evidence of medical necessity.
  • Fully prepare staff for insurance calls.
  • Ensure the highest priority cases are handled first.
  • Balance workload with assignment management.

Empower reviewers by equipping them with the best evidence of medical necessity. All relevant information for calls is summarized on a single patient summary screen. Clinicians can quickly review patient status and history to prepare for treatment team meetings and new patients.

BHCC integrates with your EMR to automate documentation gathering using industry-standard FHIR integration. Continuous auditing of EMR documentation ensures real-time accuracy. BHCC assesses documentation completion and diagnosisspecific data to determine the strength of meeting evidence of medical necessity.

BHCC supports multiple organization models from small to large health systems. UR staff can be assigned to units based on your UR structure, accommodating Centralized, Regional, Unit Based, and Specialty UR models.

Reduced Denials

The top three reasons for UR denials include insufficient evidence of medical necessity, missing documents, and scheduling problems. BHCC solves these problems. 

  • Continuously scores evidence so you know the likelihood of approval. 
  • Strengthens peer-to-peer reviews by scheduling calls through an integrated calendar. 
  • Enhance collaboration with alerts and notifications of pending deadlines and missing documents. 
  • Tracks denials to keep providers and reviewers up to date. 
  • Updates documents continuously to ensure there is no missing information when submitting final appeals. 
Denial Rate Reduction Examples
Level of Care Steps

Level of Care Transition Management

Knowing in advance whether a patient’s evidence of medical necessity is sufficient to continue the current level of care allows treatment teams and UR staff to prepare. BHCC ensures seamless transitions to new levels of care and empowers providers to make informed decisions. A step-down may be the best option to get the patient the care and length of stay as clinically indicated.

Holding Insurance Payors Accountable

Perhaps you’ve suspected that certain payors denied reimbursement more than others, but you couldn’t prove it with quantified evidence. Easy-to-use on-demand charts empower you to see how payors compare with their peers. See the big picture or drill down into the details of denial rates by payor, diagnostic class, and evidence strength scores. Enter contract negotiations with strength and results data!

Utilization Review Denial Rate by Company and Diagnosis
Increased Insight

Driving success with on-demand KPI reports

Have you ever tried managing something you are not measuring? Maybe that’s how it is with your UR process. BHCC provides 21 on-demand KPI reports for point-in-time and trending insight for UR performance, quality, and clinical performance.

UR Performance

Drill down into denials to determine potential failures and successes in your review process.

Quality

Track documentation completion timeliness and metrics related to length of stay.

Clinical Performance

View clinical staff performance promoting a culture of continuous improvement in patient care.

BHCC at a Glance

BHCC achieves quantifiable results!

With today’s tight margins and the challenges of retaining great staff, software offers the solution. BHCC improves your UR performance by helping improve results and efficiency – even during the Monday morning rush. BHCC reduces denials by analyzing patient documents from the EMR and scoring the evidence of medical necessity to help UR staff come to the calls confident and prepared, even knowing in advance if a step-down is likely to be approved. Alerts ensure that documents are on time and complete, and KPIs provide insight to improve processes and hold payors accountable.

EMR Integration

We use the industry standard of FHIR and HL7 to integrate with many EMRs, including:

Cerner
Epic
Meditech
Netsmart

Ready to learn more?

Would you like to see more? Feel free to contact us to schedule a live demo or receive additional information

Contact Us