Utilization Review

For new clients only

Utilization In-Patient Review

Process includes Pre-Admission Review which evaluates the medical necessity and appropriateness of Planned, Elective Hospitalizations. It is during the Pre-Admission Review process that early Discharge Planning begins along with PPO/Network steerage and the identification of potential Large Care & Chronic Disease Management Cases.

Our Concurrent Review process allows SRS to stay involved in the patients continued stay and assists in making sure that the length of stay is in line with the patient’s diagnosis and treatment plan. This helps to ensure that the cost of the hospital admission does not exceed what is deemed medically necessary.

Outpatient Pre-Authorization Process

This process includes a long list of procedures and tests to review for medical necessity of the surgical setting or testing facility and medical appropriateness. SRS Outpatient Pre-Authorization List can be adjusted to ensure that each client’s programs are specifically tailored to meet the needs of its participants.

For information about Utilization Review