Utilization Review

Helping you achieve higher levels of care and longer lengths of stay.

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Our utilization review department makes sure that your clients obtain the coverage they need. Our commitment is to obtain the highest level of care for the longest duration possible within payer guidelines for medical necessity. From a patient’s admission through discharge, you can rely on our educated, experienced, and skilled staff to advocate for your clients and hold payers accountable to the commitment they made to their customer’s wellness.


Receive guidance from our utilization review professionals

Through the process of initial payer approval, concurrent service reviews, appeals, and post service reviews, our aim is to obtain insurance coverage for the entirety of your client’s treatment episode at the clinically indicated level of care designated by your treatment team. Our utilization review professionals handle all communication with payers regarding authorizations, allowing your clinical staff to focus on treating your clients without the distraction of managed care.

When you join Billing Solutions, you receive a dedicated utilization review professional who functions as an extension of your clinical team. This model provides continuity of care through a client’s case. Having a designated utilization review professional who truly knows your facility and your treatment vision helps us accurately reflect the type of care your client is receiving and avoids any chances of reporting incorrect information.

In addition to obtaining authorizations, your dedicated utilization review professional is also available to provide insight and assistance in navigating the managed care landscape of private insurance. Our process is well tested and enhances the amount of approved services through third party payers. We do not just advocate, we guide.


Understand payer compliance and best practices for documentation

With an ever-changing private insurance landscape, it is imperative that facilities remain aware of payer expectations. In addition to obtaining coverage for your clients, our utilization review department also provides:

  • Education regarding program structure
  • Licensing requirements
  • Level of care guidelines
  • Intensity of service requirements
  • Individualized treatment planning
  • Clinical documentation
  • Charting to medical necessity

One of our primary objectives is to keep you informed of industry standards to promote your long-term success.


Avoid errors and delays

After we have obtained initial authorization for your client, our staff wastes no time in notifying you of the payer’s determination. As part of our commitment to provide a personalized utilization review for each of your clients, your dedicated professional will also notify you of what information is needed for the client’s next review for continued stay. Upon receipt of the requested clinical information, your dedicated professional will continue to make the case for medical necessity. The process will be repeated at regular intervals until the client is discharged from your program.


Let us be your advocate

Our utilization review team is interdisciplinary, educated, experienced, and passionate. With more than 95 years of experience combined in covering many specialties in the medical and behavioral health fields, we possess a breadth and depth of understanding that allows us to effectively advocate for a client’s treatment—regardless of their clinical presentation. With backgrounds in long-term care, hospital-based psychiatric units, residential treatment, acute detox, halfway house settings, and working in both the private and public sectors, our team not only understands your clients, but also your clinical staff.

Having worked in the field, we understand the need for ailing individuals to receive quality treatment. Our passion to participate in the healing process translates into diligence in obtaining coverage for your clients. We work with you to materialize your vision.


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