Utilization Review Services
Driving appropriate reimbursement for medical necessity determination
Optum Physician Advisory and Appeals Services help protect a provider’s revenue across all payers by accurately determining the most appropriate patient care setting (inpatient or observation) and length of stay. Our services are powered by our intelligent and scalable technology platform, enabling Optum physician advisors to deliver defensible results for medical necessity assessments and denials prevention and management.
Remote or on-site Physician Advisory Services
Optum provides on-site and remote physician advisory service options to flexibly meet your specific needs. Our on-site service expands our remote service capabilities to include clinical documentation improvement, physician coaching and other types of on-site consulting.
- Realize appropriate reimbursement through expert medical necessity determination
- Reduce administrative burden related to patient status reviews
- Alleviate compliance risk for utilization review activities
- More collaborative utilization review and CDI processes
- Improve overturn rates with stout defense of complex clinical denials
Medical necessity compliance brochure
On-site Physician Advisory Services brochure
Maximizing Peer-to-Peer Appeals with an Optum On-Site Physician Advisor
Driving Appropriate Reimbursement for Medical Necessity Determinations
Availability, Transparency, and Responsiveness
Helping Customers Succeed with Commercial Payers