Choosing utilization review (UR) software with the right features is critical to ensuring the best bottom-line results for your organization, but a system without data can leave you wondering whether UR is effective. Historically, participants in the workers’ comp industry have viewed UR as a requirement only in the states where it is mandated. But today, more carriers are making UR a priority.
UR efforts are now noted in a number of key states as a key factor in managing medical costs and appropriateness of care. A prime example relates to pharmacy. Information about the high costs of drugs associated with worker’s comp has carriers and third party administrators (TPAs) looking for methods to ensure proper treatment while managing costs.
As costs continue to rise, participants are looking for methods to identify costs that can be controlled and ways to handle claims more efficiently. With this shift, it’s important to look for system features that help you make effective UR decisions and keep your operations efficient.
Don’t wait until the end of the month to get answers to important questions! Your UR software should provide the reports you need on a daily, weekly, and ad hoc basis. Real time data can provide a huge advantage in handling claims appropriately. Often, a participant will feel as though the carrier is denying every request. The ability to pull data related to any participant (the claimant, the requesting provider, etc.) with just a few clicks of the mouse often yields the real answer. Having the option of one or multiple data parameters can alleviate concerns about excessive denials.
Are cases being transferred among team members appropriately? Who needs to review the cases, and when, to ensure processes are cost effective? Choose software that moves and shares information effectively. Ensure you can easily know this information with data driven workflows. Software should also allow workflow customization to fit your internal needs while still offering an industry specialist to help you identify workflow improvements that create efficiency.
Flexibility is crucial, and modifications should be easy. Industry changes are common and often require workflow changes. Changes resulting from CA SB 863 are a perfect example where additional pieces of information became required to complete letters and forms. It’s important to adapt software quickly with minimal disruption to add new fields that become immediately useful for reporting.
Responsiveness as a Service (RaaS)
Your system should be responsive, along with the people who service it. But what is equally important is that your system allow you to be responsive with your customers. Without high quality data, it’s difficult to respond to your clients. Your system should provide information to arrive at solutions easily and within your parameters.
Additionally, flexibility in extracting data from UR software allows users to run reports according to custom parameters. Whether sorting data by client, provider, nurse, or outcome, every report should reveal answers to specific questions or help you identify where to look more thoroughly.
ReviewStat®: Designed with Data in Mind to Optimize UR
Canned reports have their place, but meeting your organization’s changing needs will inevitably require ad hoc reporting. ReviewStat software gives users a tailored support system to optimize UR by extracting data from hundreds of fields. This provides the ability to analyze the data using your parameters. In a process where customization is key, ReviewStat allows stakeholders at every level to experience the benefits of a streamlined review process.