Reducing unnecessary and/or inappropriate provision of services is crucial to managing healthcare costs and encouraging the highest quality of care. To enhance profitability and patient outcomes, healthcare payers must efficiently review and decide on the necessity and appropriateness before, during and after services are provided.
Firstsource’s Utilization Management services help payers reduce costs while managing growing document and case volumes with greater accuracy and efficiency. Using evidence-based criteria, we review multiple types of information across your universe of health plan members – including documents, cases and letters – and ensure rapid, accurate and appropriate clinical validation from nurses and hospitals. Our utilization management services also help free up your in-house clinical teams, enabling them to focus more of their time on patient outcomes and other critical activities.
Payers understand the importance of clinical knowledge in their ability to review cases for medical necessity and make appropriate decisions. Firstsource provides professional administrative and clinical agents, leading-edge technology and intelligent, automated solutions that improve the utilization review and decision-making process.
Our end-to-end process combines the knowledgeable staff, high capacity, flexibility and automated workflows payers need to accurately and efficiently complete dozens or hundreds of cases per day. The result is system and workflow efficiencies that can be further expanded through integration with Firstsource’s digital mailroom, document, denial and customer management services.
Firstsource’s utilization management provides complete review coverage before, during and after the rendering of services to appropriately influence patient care decision-making.
Knowledgeable staff, high capacity, flexibility and automated workflows that payers need to accurately and efficiently complete hundreds of cases per day.