In the request form, the clinical user enters demographic information related to the request for an authorization such as level of urgency, diagnosis, date of patient’s admission/start date of services, anticipated discharge/end date, place of service, planned procedure and information about the providers. The authorizations have “Attach Documents” functionality allowing the nurses to attach documents provided by providers, facilities, members, and others related to the authorization request.
This is part 1 of a two part article on how Utilization Management works in Everest. Part 1 covers introduction to the module.
The role of coordinated care is emerging as a major component of US healthcare delivery models, not only as a means of improving quality of care but also for controlling healthcare costs. Our Everest product is designed to support all aspects of the care coordination process, of which Utilization Management (UM) is a key strategy.