Preauthorization and Utilization Management in Healthcare
The last thing any patient needs is to come out the other side of a medical service or procedure to find out that their healthcare claims are being denied by their health plan. Ensuring that every health service recommended to you is medically necessary is challenging, but it is vital to guarantee that you don’t face any unexpected costs. Our ICM preauthorization and utilization management processes aim to give you confidence that all procedures, hospital stays, and any other services are medically necessary and covered by your health plan.
The need for preauthorization differs depending on plan requirements. Circumstances such as surgery, hospitalization, ongoing therapy (speech, physical, or occupational), home medical equipment, chemotherapy, or radiation therapy may require preauthorization and we recommend that members or providers considering such services contact ICM to understand the preauthorization requirement(s), if any. Our preauthorization and utilization management processes seek to give you confidence that procedures, hospital stays, and any other services are medically necessary and covered by your health plan.
The Benefits of ICM’s Preauthorization and Utilization Review
For Patients
- Peace of mind knowing that your surgery, treatment, or service is medically necessary and will be reimbursed by your healthcare plan.
- Assurance that the medical service is provided at a facility covered under the plan and is appropriate for the authorized care.
- Help with discharge planning after a hospital stay, such as getting durable medical equipment in place for recovery.
- Reduced utilization of unnecessary services, such as inappropriate or unnecessarily invasive procedures or exposure.
- Professional review of the services requested by your physician, providing a second opinion to ensure that every service is appropriate and necessary for your unique condition.
For Clients
- Assurance that services are medically necessary and required for payment under your healthcare plan.
- Unbiased review of medical necessity.
- Other vendors providing medical management services may have conflicts of interest with the healthcare system they are being asked to monitor, but ICM is an independent third-party providing advice without bias.
- Assistance with direction to preferred or contracted providers, providing better payment terms.
- Early identification of high cost/complex patients, rather than discovering months later when the claim is submitted.
- Referral to other ICM programs for more specialized care and assistance.
Timely reporting of activity to other healthcare plan vendors, which directly impacts healthcare costs.
Why Choose Innovative Care Management?
At ICM, we do healthcare differently. Our top priority has always been to give our patients and clients the best quality care at an affordable price because we believe every single member we work with deserves nothing less. Our compassionate care and non-adversarial approach are why we retain more than 97% of our client base every year.
If you’re looking for medical management services for your health plan, you want to know you can trust your provider. ICM has been a reliable and independent organization for over 30 years now, doing our best to sincerely help each and every client. To find out how we can be of service to you, reach out today to speak with an ICM team member.
We work with clients and patients across all 50 states, and our focus is on delivering a premium service with a compassionate approach.
Call us today to learn more about our preauthorization and Utilization services.