utilization-review-assistant

To check medical necessity, input the patient's clinical data into the utilization review assistant to receive an assessment against InterQual or Milliman guidelines, complete with supporting rationale for the admission or continued stay.

Utilization review evaluates medical necessity and level-of-care appropriateness for patient admissions. You need it during concurrent or retrospective reviews to determine if the current ICU, Med-Surg, or Observation setting is clinically justified.

Yes, you can use the utilization review assistant to prepare peer-to-peer appeals by generating supporting rationale that evaluates admission and continued-stay criteria against established CMS, InterQual, or Milliman guidelines.

Assess level-of-care transitions by inputting current patient data to receive an immediate evaluation of continued-stay justification, which identifies whether stepping down from inpatient to observation or a lower setting meets clinical criteria.

Yes, the utilization review assistant supports both concurrent and retrospective utilization reviews, evaluating length-of-stay justification and medical necessity against InterQual and Milliman criteria for either real-time or post-discharge scenarios.

Automated criteria matching provides supporting rationale for level-of-care determination but cannot replace clinical judgment; it systematically evaluates InterQual and Milliman criteria but requires healthcare professionals to interpret the assessment for final UR decisions.