Utilization management is a critical function of health insurance carriers that ensure optimal utilization of medical resources. However, the cost of performing utilization reviews are high due to the involvement of several highly trained clinical resources.
Our trained clinical experts at Hygiea, with specialization across multiple areas use State-specific and evidence-based guidelines such as ACOEM and ODG, to perform medical necessity reviews and provide certification / non-certification recommendations based on a review of medical records and assessment of their treatment plans.
We provide Level 1, 2, and 3 support for utilization review management based on client specific needs. Our clinical resources are trained and certified in UR Management and Support by the American Board of Quality Assurance and Utilization Review Physicians (ABQUARP). The goal in our review process is to make sure that patients are getting the care they need when they need it.