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Utilization Review Services

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What Sets Us Apart

We focus on hospital Utilization Review, which means you receive excellent MD-level reviews for every case and superior customer service.

We handle every aspect of your Utilization Management from patient admission to Peer-to-Peer reviews for denials. Our review physicians are available when you need them: 24 hours a day, 7 days a week, 365 days of the year.

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Clinical Expertise and Preparation

Our review physicians provide a complete chart review of all clinical information including past admissions and conduct a clinical conference for every case.

Two physicians review every case, oftentimes three, via our proprietary Live Audit Review.

Clinical Review

We consider level of care or length of stay based on guidelines, clinical judgement, special circumstances, and payer status. The final determination is made by a small dedicated team led by a licensed board-certified physician with at least 5 years of inpatient experience as well as extensive managed care experience.

We don't tell your physicians what to do, we partner with them to ensure the best outcome for your patients as well as your reimbursement. We identify clinical issues and future considerations for your staff with each review.

100% of all cases are audited internally in order to maintain an environment of continuous learning and improvement.

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Around the Clock Services

We know the pace and constant need hospitals have for review; therefore, we offer services 24 hours a day, 365 days a year, 7 days a week. We guarantee a two-hour turnaround. We do not take holidays.

During peak hours, a third physician will review your case. It is in the busiest times, and when volumes are highest, that people are prone to mistakes. We created Live Audit Reviews for this reason.

Each review contains contact information. If your team has questions, the AppriseMD team is always easy to reach.

Our Proprietary Data Base

AppriseMD has developed a data base of all insurance payers, case denials and approvals, disease processes, medical directors’ review standards, and more. Having these resources helps improve reviews as well as the P2P outcomes.

Our industry insiders-physician advisors are experienced in utilization management and have developed relationship with payors to help improve your reimbursement rate and overturn denials for inpatient admissions.

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We have a passion for utilization management and we are always looking at ways to improve the review process at the hospital level. We don't just manage reviews, we act as physician advisors and partners.

Our Goals Are:

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Optimizing care

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Decreasing payer denials

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Maximizing revenue

For the last 1,000 insurance Peer-to-Peers completed

Cases Audited
%
P2P Completion Rate
%
P2P overturn rate
%

Utilization Review | AppriseMD

Raising the bar for your after-hours utilization review service

AppriseMD offers Utilization Review for hospitals

We offer clinical expertise combined with insurance experience to support hospitals in a highly personalized process. We value transparency and honesty.

AppriseMD 707 Skokie Blvd #600, Northbrook, IL 60062, USA

Phone: (847) 849-1970
Email: info@AppriseMD.com

You may have found us by searching other common Hospital Utilization Categories:

Utilization Review Examples

Retrospective Utilization Review

Types of Utilization Review

Utilization Review Process Flowchart

Some other important pages:

Peer to Peer Reviews
Healthcare Information Research

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