Improving UR Performance

Cut down review time, eliminate manual searches, be fully prepared for UR calls, and handle highest priority cases first

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

Why is Behavioral Health Utilization Review So Hard?

Heavy reliance on narrative documents, manual searches, gathering evidence of medical necessity, and not enough time. Sound familiar? If UR is not properly executed, the patient pays a price with premature discharge. With tight deadlines, time-consuming and error-prone manual processes make it difficult to get UR right. The cost of the status quo is high, and your facility pays the price with increased denials.

There’s a better way!

Behavioral Health CareChain (BHCC) Solves today’s Utilization Review Problems

Without a doubt, the economic sustainability and growth goals of any healthcare facility can only be achieved through the advancement of UR operational best practices. BHCC’s software automation is a game-changer in this regard, enhancing UR results by boosting staff efficiency and productivity.

  • Getting on-time document completion

  • Publicized and prioritized deadline schedules

  • 100% of evidence of medical necessity captured and quantified well in advance of your UR calls

  • Complete preparation for every UR call with instant access to supporting documents

  • Level of care transition alternatives highlighted for the UR nurse at call time

Seven Ways AI Software Can Help

  • Search the EMR for evidence of medical necessity.

  • Know historical data for denials by on evidence score.

  • Know if an alternative level of care would stand a better chance of authorization.

  • Have UR nurse 100% prepared for call with instant access to needed documents.

  • View a patient summary showing medical criteria, review summary, case history, and easy access to all chart documents.

  • Quantified evidence strength scores and approval history

  • Peer-to-peer call preparation with all evidence added after the concurrent review highlighted and easily accessible.

Get Patients the Care They Need

With higher UR nurse productivity, more time becomes available for work on weaker cases. Knowing you have the strongest criteria score maximizes the likelihood of an approval. If the case is unlikely to be approved at the current level of care, the UR nurse can know well in advance if it would be more likely to qualify for a step-down.

Evidence of Medical Necessity 1

Medical Evidence Scored with AI

BHCC uses AI’s Natural Language Processing (NLP) to locate and interpret provider and nurse notes, scouring for strong evidence of medical necessity based on the patient’s diagnosis. It quantifies scores and rankings for medical necessity to prepare nurses and other clinicians for each step of UR. The nurse can set aside strong cases to focus on weaker ones. If a case needs stronger or additional evidence, the reviewer can immediately alert clinicians. Time saved! Work prioritized! Results improved for patients and staff!

What’s the Bottom Line?

It’s all about results. Contact us to learn how these organizational units become strengthened by using ARGO BHCC.

  • Denial management

  • Payor performance management

  • Patient level-of-care management

  • C-level KPI insights

  • Medical directors and CNOs

Ready to learn more?

Contact us to schedule a live demo or receive additional information

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