Utilization Review – Our Smart UR

The Utilization Review functionality allows authorized users to record and track insurance authorizations, with their associated levels of care, date range, as well as the insurance company’s care manager, under the Concurrent Review section of the Information Tab (FaceSheet).

Utilization Review can record your organization’s internal users (user roles: Utilization review internal and Super Admin), or an external provider (user role: Utilization review external) – when using the external provider setting, an internal user will need to release UR documents as needed.

Adding a Care Manager

A Care Manager is the insurance representative that talks with the KIPU user to present the case.

Simply click Add Care Manager in the Concurrent Review section.

Enter the information and click Save Care Manager. You can add as many Care Managers as needed.

Adding a Review

To add a review, and record the authorization for services, click on Add Review.

Enter all the available information:

  • Authorization date: date that the authorization was acquired
  • Number: number of days or units of treatment (for example: sessions) authorized
  • Frequency: select from your custom drop-down options, as set up in Settings/Patients
  • Level of care: select from your custom drop-down options, as set up in Settings/Patients
  • Start/End dates: date range of the authorization

You may add as many reviews as needed throughout the episode of care.

Once the review is entered, it will display for authorized users in the Information Tab (Face Sheet), newest on top, oldest in the bottom

  • Last coverage date: select this checkbox if the end date is the same as the patient’s discharge date (end of the episode of care)
  • Authorization number: the reference number provided by the care manager
  • Next review date: date of next review
  • Insurance company: select from drop-down options (when patient has more than one insurance)
  • Comment: enter any pertinent comment, for additional reference

For Utilization Review External Setting

When an organization uses this setting, the external provider only has access to documentation that has been released by facility personnel. This means that the Utilization review external user will not see any patient, or individual documents, that have not been actively made available for them to see. This is especially useful for the provider; to prevent access to non-applicable records, for example, self-pay patients’ records.

Using this feature is useful for organizations that want to review and approve all the content, and make sure the treatment documentation is up to their standards, and abides by the organization’s Policies and Procedures, before the UR provider makes a call to the insurance company.

Settings

Your organization’s Super Admin will designate which chart tabs may contain relevant UR documentation in Settings/Patients

Internal User Authorized to Release Information

Any user with the added feature Manage utilization review is able to grant access to a patient, and release individual pieces of documentation such as evaluations and consents.

Granting Access to a Patient Information Tab (Face Sheet)

The authorized facility user will access the Edit mode of the Information Tab (Face Sheet), and select Allow UR, next to the MR#.

Releasing Documents

The user will locate the needed document, and select / allow UR if applicable. Once the checkbox is selected, the Utilization review external provider will have access to the selected document(s)