Utilization Management

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Maintain Efficient Utilization of Healthcare Resources

AveCare's Integrated Utilization Review process supports a variety of Utilization Review functions for both inpatient and outpatient services enabling health delivery organizations to streamline medical review while maintaining Efficient Utilization of healthcare resources.

  • Review Management:  Processes for all aspects of utilization management including: prior authorizations, referrals, initial & concurrent, compliant & retrospective reviews.
  • Notifications: Automated referrals to case management triage and notification to case managers that a pre-certification has been received. 
  • Review Tools:  Features to enable efficient and speedy handling of cases including: copying of outpatient reviews to inpatient, automated letters, automated urgent queue tasks and many more.
  • Medical Panel Review:  Includes utilization of both internal and external medical review.
  • Appeals:  Detailed tracking of the appeal process. 
  • Criteria Integration: Provides interactive or online criteria solutions with multiple vendors.
  • Correspondence:  Integrated letters program to  facilitate compliance during the utilization management process. 

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