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!
Six Ways BHCC Improves UR Operational Efficiency
Medical Necessity Evidence Scored with AI
BHCC uses AI’s Natural Language Processing (NLP) to locate and interpret provider, clinician, 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 UR staff for each step of UR. Staff 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!
Creating Efficient, Stress-Free Workflows
Improved efficiency scales productivity during peak times. BHCC eliminates the need for time-consuming manual searches through documentation to find the evidence needed to get payor approval. The solution finds, filters, prioritizes, and scores evidence based on diagnosis. UR staff can quickly compare cases’ readiness and know how to use their time most effectively to get the best overall results. The boost in peak-time productivity reduces stress and boosts confidence.
Staff Flexibility and Process Scalability
Flexible UR models support organizations of all sizes. UR staff can support one or more facilities onsite or remotely. Staff can be generalists or specialists within a specific region or across the enterprise. Institutional scaling allows skilled staff to focus on what they do best – at scale.
The rapidly changing needs and time-sensitive nature of Behavioral Health require solutions that simplify shifting staff needs. Whether a UR staff member takes scheduled PTO or calls in sick, BHCC simplifies reassigning patient workflow.
- A UR Supervisor can change the absent UR staff’s status so new patients are assigned to alternate staff members as appropriate. Upon return, flipping the status back resumes the original patient assignment flow.
- The UR Supervisor can quickly reassign existing patients individually or as a group to different UR staff, even if those staff work in different physical locations.
BHCC load balances to reduce staff overload. If a UR Supervisor assigns multiple UR staff to a unit, workload imbalances of greater than two patients result in the assignment of subsequent patients to the UR staff with the lighter load.
Meet the Need for Organizational Growth
BHCC accommodates multiple staffing structures to foster a flexible and supportive environment, empowering teams to work in the ways that best suit their roles and workflows. Adapting to various departmental needs, no matter the structure, reduces friction, streamlines processes, and supports collaboration across all levels of the organization. This flexibility not only improves staff satisfaction and retention but also enables scalability, allowing organizations to grow, add new service lines, or extend locations without overhauling their operational systems. The result is a workplace that can evolve alongside the organization’s goals while maintaining efficiency and quality of service.
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.
Ready to learn more?
Contact us to schedule a live demo or receive additional information.
