Utilization Management

Utilization Management is the evaluation of the appropriateness and medical need of health care services, procedures and facilities, according to preset criteria or guidelines, and also under the provisions of an applicable health benefits plan. It is a critical and core component of the healthcare system in the US and requires professional expertise to a very high extent.

We specialize in providing our clients with a full range of Utilization Management services for Part A, B & D. Trust our accurate and timely reports, strict adherence to UM codes, efficient evaluation by qualified medical professionals and proven expertise to bring you robust and reliable Utilization Management solutions.

If cost-effective Utilization Management services are on your mind, look no further than Sun Knowledge. Contact us today!

Highlights

  • Dedicated team comprising physicians and pharmacists
  • Medical transcription of clinical notes to aid in decision making in client specific systems
  • Collection of additional clinical information from physician’s office
  • Final decision made by qualified physicians and nurses in the US
  • Reducing the standard procedure turnover time from CMS mandated 30 days to 7 days for Part A & B Utilization Management and from 72 hours to 48 hours for Part D Utilization Management
  • Expedited procedure to determine authorization within 24-36 hours
  • Standardized process and effective application of appropriate tools before rendering any decision
  • Specialized clinical customer support 24×7 Help Desk

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