Explore articles focused on Utilization Review. This category delves into Utilization Review and its impact on improving patient care quality while controlling costs. Discover insights into how Utilization Review helps reduce unnecessary medical expenses and ensures care delivery aligns with industry guidelines. Dive into topics related to Utilization Review software, its role in streamlining processes, supporting data-driven decisions, and promoting efficient healthcare management and informed documentation. Explore this category to identify areas for improvement within your case management and healthcare practices.

Is Your Case Management & Utilization Review SOC 2 Certified?

Companies in the workers' compensation industry have strict security requirements for the software their partners use, which houses HIPAA-sensitive and patient/injured worker information that needs to be protected. This will be reflected in the bidding and sales process as DataCare's SOC 2 Certification guarantees that the following can be provided with confidence: Security Details System Availability [...]

2023-10-09T19:54:17+00:00October 2nd, 2018|Utilization Review|

Drug Formulary: Quick and Easy Approvals with UR++

Express authorizations can be performed faster and more easily with the use of drug formularies. The recent release of the California Drug Formulary uses a very objective language suitable for fully- or partially-automated approval of requests. For example, after entering a medication request in DataCare’s UR++ system, the system can easily determine if the request [...]

2023-10-09T19:59:16+00:00June 27th, 2017|Utilization Review|

Cutting Complexity in Workers’ Compensation Utilization Review Programs

DataCare UR++SM reduces utilization review program costs by enabling claims adjusters and trained administrators to routinely approve 80% or more of all treatment requests and by significantly reducing the number of referrals to more expensive nurse or physician reviews. Quick approvals also shorten the time it takes for employees to return to work. With the [...]

2023-10-09T19:58:10+00:00June 7th, 2017|Utilization Review|

Does Your Utilization Review Team Have the Tools It Needs?

Utilization review (UR) organizations need to coordinate the efforts of highly skilled professionals on a tight timetable. This makes modern technology a requirement for a top-performing team. According to Dr. Doug Benner, who led Kaiserʼs occupational health services for 30 years and now serves as medical business product development officer at EK Health, the [...]

2023-10-09T19:42:51+00:00April 28th, 2017|Utilization Review|

UR++ 1.4 for Adjusters and Claims Professionals

DataCare is proud to present its latest release for Adjusters and Claims Professionals: UR++ 1.4 WHAT'S NEW Adjusters/ Claims Professionals come across several Request for Authorizations (RFAs) each day, and some cases may require additional attention. For this reason, the latest version of UR++ enables clients to incorporate a best practices ruleset to make [...]

2023-10-09T19:57:43+00:00March 24th, 2017|Utilization Review|

Benefits of Integrating CM, UR and Adjuster Software Modules

Companies involved in Workers’ Compensation will typically use Utilization Review, Case Management and Claims Management software independent of one another. The Ahshay core software platform achieves higher efficiency, savings, and detailed reporting by combining these modules under one platform. Within DataCare‘s core platform Ahshay, Utilization Review, Case Management, and the claim enhancing Medical Process [...]

2023-10-09T19:57:00+00:00November 7th, 2016|Utilization Review|

When is the UR Enforcer Necessary?

Workers comp administrators receive 200 to 300 bills a day which need to be directed to adjusters. However, the adjusters don't necessarily review the bill, even though numerous incidents occur when they are sent out for the wrong reason. Some of these reasons may include a bill for unnecessary treatments, fee schedules changing frequently, or even [...]

2023-10-09T19:50:48+00:00March 2nd, 2016|Utilization Review|

DataCare Delivers SB 863 Compatibility from Day 1

Since January 1, 2013, DataCare has been SB 863 Compliant. SB 863 is changing the face of workers’ compensation in California and DataCare has worked hard to ensure that our clients are ready to handle 2013 claims. SB 863 has two changes that may require significant amount of labor and additional costs to payers [...]

2024-07-03T16:47:33+00:00January 28th, 2014|Utilization Review|

DataCare’s UR++ Software Streamlines Treatment Decision Process for AARLA

Integration with DataCare’s UR/Case Management system creates a fully integrated system for applying evidence-based medicine to workers’ comp claims. SAN JOSE, Calif., September 29, 2012 American All-Risk Loss Administrators (AARLA), a leading third party administrator and provider of claims services, has selected DataCare's UR++ software, part of DataCare’s Ahshay® platform, to facilitate workers’ compensation treatment [...]

2023-10-09T19:51:03+00:00September 29th, 2012|Utilization Review|
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