Create U/R Plans - EMR + RCM

The Utilization Reviews section of the EMR allows you to add a utilization plan, also known as a U/R plan, authorizing patient treatment for both Level of Care (Per Diem) and Standalone services. In the RCM, these plans provide the information necessary to create and submit a claim.

User Permissions

In the EMR	In the RCM
There are multiple user types in the EMR that can add and manage U/R plans in the EMR. For more information on these roles, click here.	Managing Organization Admins and Organization Admins can create and manage U/R plans by default. User-level profiles require additional permissions before accessing the U/R section. For more information on user roles and permissions, click here.

Workflows

Let's review how to create a U/R plan for both Level of Care and Standalone services!

1. Open the patient's chart in the EMR.
   
2. In the Information tab, scroll to the Utilization Review section.
   
3. Next, click Manage Review.
   

• Use this process to transmit charges for Level-of-Care services.
   
  4. Use the instructions from this article, starting with step 4, to fill out the information required for a Utilization Plan.
  5. When complete, click Close & Refresh to complete the process.
• Use this process to transmit charges for Ancillary services
  4. In the iframe, click the Service Rates tab.
     
  5. Use the instructions from this article, starting with step 4, to fill out the information required to create a Standalone Authorization.
  6. When complete, click Close & Refresh to complete the process.
     

Manage U/R Plans

Let's review some common scenarios for managing a U/R plan together!

• If the payer authorizes additional units and assigns a new authorization number, create a new U/R plan using the steps outlined above.
  
  If the payer authorizes additional units under the same authorization number, follow the instructions outlined here to update the number of units.
• If the patient has a secondary and/or tertiary payer that requires an authorization, refer to step 10 of the creation process outlined here.
• If a claim went out with incorrect authorization information, click here for instructions on how to change the U/R plan and generate corrections with the correct U/R plan information.