DataCare is proud to present its latest release for Adjusters and Claims Professionals: UR++ 1.4
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 approvals only under certain conditions while incorporating all elements of the claim life cycle.
For example, if we take an RFA with ICD code G56.00 “Carpal Tunnel” with a treatment request for additional Physical Therapy, there are some companies that may want to incorporate a condition such as “Only approve up to 6 additional visits with documented increased functions…”. These types of rules will allow the claims staff to make more informed decisions when reviewing treatment requests. With this update, the system will automatically notify the user if the specified treatment requires any conditions before making the approval. In addition to the conditional approvals, this update also provides a ‘Claim Treatment History’ tab to aid in the claims workflow.
How will these updates affect the user workflow?
Since some clients may require their users to indicate clearly that they took conditions under consideration before making a decision, the claims staff can mark whether the specified conditions were met/unmet. This will improve the granularity of information when reviewing past approval decisions. Lastly, users will be able to save significant time in their workflow during the authorization process since the treatment history information is now readily available.