Pre-Authorization & Utilization Management

Pre-Authorization & Utilization Management

Insurers are increasingly contracting with third-party vendors of utilization management programs, or “UM,” to administer the rehabilitation benefit. This can create both challenges and opportunities for behavioral health addiction treatment centers.

Before insurance companies will agree to pay for some medications, medical procedures, and medical equipment, they require advance notice. Utilization management programs are also an essential part of a provider organization’s revenue cycle, helping to prevent unnecessary costs and claim denials.

Expert Advocates, Effective Appeals

At Synergy Concepts, our utilization review specialists are passionate professionals with experience specific to the behavioral health field.

Our pre-authorization and utilization review services are conducted by our team of qualified insurance management process experts to ensure your patients receive the best advocacy and treatment possible.

We work closely with our addiction treatment and behavioral health providers to make sure they understand the key elements of the authorizations process, including but not limited to; superior clinical documentation, medical necessity guidelines for each insurance carrier, intricacies of the authorization, and utilization review processes.

Quality Services

Our team has developed a solid reputation as ethical and caring for you and your patients. We know what information is needed and work closely with clinical staff to monitor and review behavioral health services rendered, provide clinical data on diagnosis, diagnostic test results, symptoms, and conditions supporting the requested services in order to obtain the highest number of authorized days.

Our Behavioral Health Utilization Management Services Include:

  • Pre-authorization of services
  • Concurrent planning, discharge planning
  • Medical record review to determine proper documentation supporting billed medical services
  • Assist in educating clinical staff in medical record reviews and clinical case appeals, to show proper documentation that supports the billed services

Valuable Services

Experienced the value of our tried and true utilization management approach. We have an effective appeal process with elevated overturns 44% of authorization denials. Let us help you control health care costs, increase revenue, and improve patient outcomes.

Contact Synergy Concepts

Contact us to find out how Synergy Concepts can help your business, too. Send us an email using the form below with any questions you have about working with us.