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.

Key benefits:
  • 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

We're ready to put our solutions to work for you. Let's start the conversation.
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