Utilization Review

If you work with claims, you’ve seen how the quality of your utilization review (UR) services can make the difference between a claim easily resolved or a long, drawn-out and expensive claim. Our UR services include:

  • Active licenses or certifications where required
  • Full compliance with timeframes and other jurisdictional regulations
  • URAC compliant core standards
  • Exceptional documentation
  • Customized workflows for clients

Keeping You in the Loop

While compliance and quality are always top priorities, UniMed Direct offers much more. We take pride in documenting our nurses’ rationale when approving requested services. And we take care to communicate early to the parties involved in the claim. Our UR also includes:

  • State-specific or evidence-based guidelines applied to approvals and denials
  • State-required evidence-based guidelines such as ACOEM and ODG when applicable
  • UniMeviDence® – our proprietary collection of evidence-based criteria for approvals and denials where state mandated guidelines are not required
  • Evidence-based support throughout appeal process levels

Click here to request more information about utilization review.