U/R Report

The U/R Report enables users to visualize total and average authorizations and trends (by payer, location, service, and level of care) to optimize revenue through data-driven decisions on admissions, staffing, and processes.

Generating the Report

Let's review how to create the U/R Report! 

1. Navigate to the Reporting section.
   
2. Under Utilization Management Reports, select U/R Report.
   
3. Update the filters to specify how the system should generate the report.
   
4. Then click Run Report.
5. To include data from the last 24 hours, select Refresh Data.
   
6. To download a copy of the report onto an Excel spreadsheet, click Download.
   

Available Filters and Definitions

• The Selected Practices filter allows users to filter search results based on the practice under which claims were submitted.
  
• The Authorization Status filter allows users to include or exclude certain plans based on their status within the specified date range.  Users can further customize the report by selecting multiple statuses at one time. These options include:
  • All
  • Authorized
  • Denied
  • Not Required
  • Pending
  • Required-Not Obtained
    
• The Date Type is used as a qualifier to instruct the system which plans should be included in the report.
  • U/R Plan Start Date (default) will show all U/R Plans with a start date within the selected date range
  • U/R Plan End Date will show all U/R Plans with an end date within the selected date range
  • Patient Discharge Date will show all U/R Plans for patients with a discharge date within the selected date range
  • Anticipated Discharge Date will show all U/R Plans for patients with an anticipated discharge date noted in their profile within the selected date range.
    
•  The Start Date and End Date define the timeframe within which the system locates and includes plans based on the Date Type and Status. 
  
• The Show Discharged filter instructs the system to include any patient with a plan that qualifies but has since been discharged.
   
• The Include Prospective Auths filter instructs the system to include any patients with a qualifying plan who have not been admitted. 
   

Viewing the Report

The U/R Report produces a table in which each row represents a U/R plan with a start and end date within the specified time frame.

Columns and Definitions

Column Name	Where to Edit
Patient Name	Patient > Profile
Patient ID	Patient > Profile
MRN	Patient > Treatment Episode > Intake > Admit/Discharge
Payer Name and Home Plan.	Patient > Treatment Episode > Intake > Insurance > Insurance Set
Insurance ID	Patient > Treatment Episode > Intake > Insurance > Insurance Set > Policy Holder
Admission Date	Patient > Treatment Episode > Intake > Admit/Discharge
Discharge Date, Discharge Status, Anticipated Discharge Date.	Patient > Treatment Episode > Intake > Admit/Discharge
Plan Type, Service, Service Billing Profile.	Patient > Treatment Episode > Scheduling and Utilization > U/R
Authorization Start Date and Authorization End Date.	Patient > Treatment Episode > Scheduling and Utilization > U/R
Units, Authorization Status, Authorization Number.	Patient > Treatment Episode b Scheduling and Utilization > U/R
Case Manager and Insurance Case Manager.	Patient > Treatment Episode > Scheduling and Utilization > U/R
Billed (#) Units and Remaining Units	Patient > Treatment Episode > Scheduling and Utilization > U/R
Rendering Provider and Follow-up Date	Patient > Treatment Episode > Scheduling and Utilization > U/R
Practice	Patient > Profile
Facility	Patient > Treatment Episode > Scheduling and Utilization > U/R

FAQ and Helpful Hints

Let's review some facts and questions about the U/R Report!

• The plan information is the same in the U/R Work Center and the U/R Report, except that the U/R Report includes all U/R plans within a given timeframe, whereas the U/R Work Center currently shows only active plans. Users may wish to download the report to analyze the U/R data or print the report to send to management or investors. 
• Some of the more common use cases are listed below:
  • Determining how many days and units each team member is getting authorized
  • Determining how payers authorize services and lengths of stay for reimbursement and revenue potential forecasting.
  • Determining which payers to focus on during patient intake

Helpful Hints

• Use Pivot Tables: If you're downloading the report to Excel, consider using Pivot Tables to arrange data easily with your U/R report, then open the CSV file in Excel. Here's how: Create Pivot Tables To Analyze Data
• Status Checks: Run weekly and monthly. Data can be pivoted for Case Manager LOC and Payer Performance. 
• Refining your Search: Search by patient name to filter the report without downloading it to Excel.

• U_R Report - Demo.xlsx 10 KB