Utilization Review Strategy and Training
Accessing behavioral health benefits through the utilization review process continues to be challenging, despite legislative efforts and class action lawsuits that hold insurance companies accountable for denying or limiting access to care.
Authorizations can vary by payer and UR rep, so it’s important to track your authorization data to identify trends, training needs, and identify potential managed care contract opportunities. Substance use and mental health patients are routinely denied care or forced to step down to a lower level of care prematurely by insurance company care managers and doctors. In many cases, this happens because the person requesting authorization is not prepared with/cannot articulate clinical information that clearly demonstrates medical necessity for treatment.
When this happens, care managers don’t trust the information your company provides and may quickly default to premature denials. Census By Design specializes in the evaluation of treatment center utilization review teams and practices in order to provide training and tactical strategies that maximize coverage for your patients.
For census growth, it’s important that your facility develop a partnership with care managers by only requesting authorization at the level of care supported by clinical documentation. With proper training and documentation, you can secure the longer lengths of stay at the level of care your clients need.
