Utilization Management e1662576415456
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The Perfect Partner

Experienced Experts. Exceptional Service and Results.

 

With 50 years of managed care experience, you can be confident that MP CareSolutions understands that utilization management is a difficult balancing act between patient care, medical costs, and regulatory requirements. More importantly, we have mastered the “how to”. With timeliness, compliance, and efficiency at the forefront, we blend our knowledge with an understanding of your needs to develop and execute UM programs that are just right for your organization. As your dedicated partner, we can take the weight off your shoulders and expertly support your organization in optimizing utilization management.

 

Let our Expertise Drive Your Success.

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100% Compliant with State Department of Health regulations with no audit findings or citations.

RN Chart Audit Scores at 99% or greater using InterQual Criteria

100% Customer Satisfaction consistently meeting all established service level agreements

100% Inter-Rater Reliability Score

Physician Satisfication is consistently 95% or higher

A Comprehensive Approach to Utilization Management

Medical care is increasingly complicated. The explosion of technology and home-based services along with consumer-directed information has created new, difficult to manage requests for treatments that can increase costs and compromise care. Our clinical review staff expertly handles new UM challenges, as well as the more traditional requests.

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The Fundamentals

MP CareSolutions services Medicaid, Medicare, Accountable Care Organizations, special-needs plans, Patient-Centered Medical Homes, and other models of care delivery.
Our team reviews pre-service, concurrent, and post-service determinations in all service categories including medical, mental health, chemical dependency, and personal care. We always starts with implementing standardized procedures that ensure regulatory compliance but we don’t stop there.

    The MP CareSolutions Difference

    • Bring extensive experience supporting large health plans and unique benefit of having operated a health plan.
    • Consistently use national, best-practice, evidence-based criteria for approval or denial of services.
    • Comfortably collaborate with providers to ensure the best care while protecting resources.
      Skillfully analyze utilization and cost data to improve processes and contain costs.
    • Proactively identify complex cases for care coordination and develop custom, cost effective care plans.
    • Leverage our NCQA Accreditation and Utilization Review Agent designation to benefit the patient and our customers.
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