Utilization Review [Beta]

  • Updated

This interface is currently in limited release to a select group of clients and will be rolling out to everyone in the coming weeks.

Avea is thrilled to announce a newly improved user interface for Utilization Reviews. This update simplifies the process of creating and managing Utilization Reviews by providing quick links and process improvements. Now, users can create new Authorization Plans for patients with primary, secondary, and tertiary insurance all within the same window. Additionally, users can create Standalone Plans and Private Pay Plans using the same process.

Authorization Plans

To record attendance for a U/R Required service, an Authorization Plan will need to be established within the patient's treatment episode. The information within an authorization plan provides the system with a blueprint of how a claim should be created. Let's review how to create an Authorization Plan!

    1. Navigate to Patient > Treatment Episodes.
       
    2. Under the Quick Links, select U/R.
    3. Next, select Create Utilization Plan.
    4. Input the Start Date and End Date.
    5. Next, update the Facility and assign a Case Manager.
    6. Select the Service then update the Service Billing Profile dropdown.
    7. Update the Rendering Provider information.
       
    8. Under the Primary Payer section, update the Payer dropdown.
       
    9. Next, input the number of Units.
    10. Update the Authorization Status.
       
    11. Input the Authorization Number.
    12. Next, set the Follow-Up Date.
       
    13. Add any pertinent Payer Notes.
    14. If the patient has secondary (or tertiary) insurance, select Add Secondary Payer and repeat steps 8-13.
    15. Once all fields have been filled out, select Create Utilization Plan to complete the process.
       

Standalone Plans

Standalone Plans allow a user to create authorization plans for non-U/R required services. Let's review how to create a Standalone Plan!

    1. Navigate to Patient > Treatment Episodes.
    2. Under the Quick Links, select U/R.
    3. Next, select Create Utilization Plan.
    4. Select Standalone Plan.
    5. Input the Start Date and End Date.
    6. Next, update the Facility.
    7. Select the Service.
    8. Update the Payer dropdown.
       
    9. Then, input the number of Units.
    10. Update the Authorization Status.
    11. Input the Authorization Number.
    12. Set the Follow-Up Date.
    13. Add any pertinent Notes.
    14. Select Create Utilization Plan to complete the process.
       

Private Pay Plans

Private Pay Plans can be created to instruct the system to generate a patient billable when a medically classified service has been recorded. Let's review how to create a Private Pay Plan!

    1. Navigate to Patient > Treatment Episodes.
    2. Under the Quick Links, select U/R.
    3. Next, select Create Utilization Plan.
    4. Select Private Pay Plan.
    5. Input the Start Date and End Date.
    6. Next, update the Facility.
    7. Select the Service.
    8. Enter the Unit Rate.
    9. If desired, assign the Case Manager and select a Rendering Provider.
    10. Set the Follow-Up Date.
    11. Add any pertinent Notes.
    12. Finally, select Create Utilization Plan to complete the process.
       

Managing Plan Information

Managing U/R plans has never been easier! Let's review our new features and how they can improve your workflow.

Custom View

With the new interface, users will be able to customize their view of the section by selecting View Columns.

Facility and Rendering Information

Each Utilization Plan will include the Facility's NPI and the Rendering Provider's NPI below the hyperlink. Users can now quickly access both the Facility and Rendering Provider profiles by simply selecting the quick link if additional information is needed. This will open the profile in a new browser tab, allowing users to view all profile information without navigating out of the section. Click here to learn more about editing facility information. Click here to learn more about editing rendering provider information.

Documentation

Users can now add notes to the plan by selecting New Note. Additionally, users can now also upload any related documentation using the New Files link.
 

Existing Plans

Users can manage existing plans by selecting the Edit option. Once the necessary changes have been made, select Update Utilization Plan to complete the process.

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