Problem
At a large insurance carrier, adjusters were manually tracking utilization review (UR) determinations and cross-referencing them with incoming medical bills, often across multiple claims. Their traditional manual approach to UR was time-consuming, prone to human error and made it difficult to catch when providers billed for services that had previously been denied or exceeded the authorized limits. As a result, they paid for non-authorized treatments and lost productivity as their adjusters had to spend valuable time on administrative tasks instead of higher-priority responsibilities.
Download the case study to see how implementing Utilization Review Decision Manager (URDM) helped them reduce manual touchpoints, improve provider adherence, and strengthen their bottom line.
2M in Savings Captured Within One Year
5% of Bill Volume Impacted Through Automation
41% Increase in Bill Review Savings