DataCare offers a proprietary method for clients to approve treatment requests in a simple and expedited manner. Create express approvals with UR++, which reduces utilization review program costs by enabling claims adjusters and trained administrators to routinely approve 80% or more of all treatment requests and 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.

Express Claim Approvals With UR++

• Clients use their own business rules as the basis for configuring the system and can take into account evidence-based guidelines and state-specific mandates.
• Using predictive modeling methodology, we help locate the critical information needed from medical reports to prioritize and route the referral to facilitate the initial processing of requests.
• Client-defined workflows then route treatment requests to appropriate personnel, and non-medical personnel can handle 80% or more of the requests.
• Non-medical personnel views request for authorization and medical reports with all the information they need for a quick and thoughtful decision. This includes a summary of all past requests and past-paid treatments. Claims examiners and administrative staff select treatment options from a menu written in plain English.  They do not need to understand medical codes or complex treatment guidelines or answer complex medical questions.
• Claims examiners or administrative staff can immediately escalate a file for nurse or physician review based on treatment history or any other issue within the application. This reduces inefficiency and time spent generating referrals to the nurse or physician reviewers.
• If the treatment is approved, the system automatically sends authorization notification letters and faxes to injured workers and providers.

Paulo Franca, Ph. D., DataCare’s President and Chief Technology Officer, commented, “Our customers have told us that systems claiming to provide “automated approval” end up approving too many expensive treatments that should have gone to physician review. Our system balances a decision-support system with human judgment on the complex treatment needs of workers’ compensation claims.”

DataCare’s new Express Approval (UR++) can support multiple business rule sets, depending on the type of claim, and works well for organizations operating in multiple locations.