Utilization Review Software Solution
Utilization Review Software Built for Your Team
Standardize how requests move from intake to determination, automate routine work with rules you set, and stay consistent across jurisdictions without losing visibility.
MORE UTILIZATION REVIEW SOLUTIONS
Key Metrics
50%
UR Case Volume Auto-Processing without Nurse or Physician Review (Based on Rules and Guidelines Configuration)
+7%
Additional Efficiency Gain Through “Claim PreCheck” in Jurisdictions Where Administrative Denials Can Be Automated
Benefits
- Standardize how review requests are received, routed and resolved across your team
- Cut manual work with configurable automation for approvals, assignments and notifications
- Strengthen decision consistency with guideline-supported tools and clear documentation you can see and trust
Features
Configurable Workflows and Rules
(Routing, Assignments, Notifications)
Automated Guideline and Rules-Based Processing for Routine Requests
Compensability and Claim Validation Pre-Checks
Jurisdiction Due-Date Rules and Compliance Controls
Workload Balancing and Role-Based Routing
Make UR Decisions Stick With Utilization Review Determination Manager (URDM)
URDM connects determinations to bill review so enforcement is consistent and measurable. Decisions automatically apply to incoming bills and exceptions are flagged fast, reducing overpayment leakage and manual matching by adjusters.
Industry Trends and Insights
Get the latest insights and industry updates you need to know.
Frequently Asked Questions
How much control do we keep if we run utilization review in-house?
You keep full ownership. Your team sets the workflows, routing rules, and automation guardrails so routine requests can move fast, and exceptions route to clinical review with clear visibility throughout.
How quickly can we update rules when policies or regulations change?
Routine rule updates can often be completed within one business day, so you can respond fast without destabilizing operations. More complex requests that require new logic take longer and we will set clear expectations based on complexity.
How does the platform support compliance across different states?
The platform supports jurisdiction due-date rules and compliance controls, including the ability to manage your state-specific rules or use system defaults. It is designed to help you stay aligned to state timelines and documentation expectations as requirements shift.
What helps us stay ahead of regulatory change, not just react to it?
You are backed by a compliance capability that is dedicated to monitoring utilization review regulations, plus platform controls that help you operationalize changes quickly and consistently.
How much work can automation realistically handle?
Automation can process a meaningful portion of routine volume based on your rules and treatment guideline configuration. Internal performance examples show up to 50% of UR case volume can auto-process without nurse or physician review, and claim validation plus compensability checks can automate certain administrative denials (about 5% in the cited example).
How do we keep clinical decisions consistent across reviewers?
Guideline-supported tools drive consistent decision-making, and the platform captures detailed activity and documentation to support quality oversight and defensibility when cases escalate or get challenged.
Can we add peer review only when needed?
Yes. The platform supports integration with Enlyte’s peer review panel or a peer vendor you select, so you can route escalations through your workflow without rebuilding your process.
Will it integrate with our systems and partners?
Yes. The platform supports integrations through application connections, including partner and vendor integrations, so UR activity and decisions can move downstream where they need to be.
Let’s Connect
Let’s collaborate to see how we can provide your organization with an effective, efficient and compliant utilization review solution.