January 2025

Case Study pediatric short stay

Case Study: Pediatric Short Stay Denial Reversed

Case Study, Denial Management, Peer-to-Peer / By

CLINICAL SUMMARY: A previously healthy six-year-old boy arrived in the emergency department with chest pains and a high heart rate of 240 bpm. Upon arrival, he was hemodynamically stable and had no mental status changes. The symptoms began during an evening soccer practice and continued once he was at home. His mother, who has a […]

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Physician Advisors: Specialists for your Utilization Management Team

Physician Advisors: Specialists For Your Utilization Management Team

Blog, Utilization Review / By

Physicians specialize in medicine for various reasons, though primarily to improve patient outcomes by providing more focused care and reducing medical errors. This also allows physicians to see more patients in a period, making them more efficient at delivering quality care. The concept of specialization in healthcare is not new, however it is not always

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