Utilization Management
Companies are continually looking for ways to lower claims costs. Mutual of Omaha finds increasing value in Utilization Management (UM) programs to help control rising health care costs with a return on investment of 2 to 1.
An integral element of Mutual’s medical management program, our UM program reviews specific inpatient and outpatient services and procedures to determine if they are medically necessary and appropriate.
Benefits of Our Utilization Management Program
- Effective care management across the continuum
- Early referrals to Case Management and Disease Management programs
- Determines suitable lengths of stay and appropriateness of services being provided
- Timely transitions to lower levels of care
- Appropriate discharge planning
- Redirection of care to in-network providers
- Reduction of overall claim spend and plan member out-of-pocket costs due to elimination of unnecessary medical services
Precertification Reviews
Mutual’s Utilization Management program has recently added two new areas -- outpatient high end radiology services and specialty drugs and medicines -- for which plan members must precertify their care in addition to the following:
- Inpatient confinements
- Selected outpatient surgical procedures
- Specialized home health services and supplies
- Behavioral health – inpatient care
- Behavioral health – outpatient care
Our precertification reviews help you reduce claims costs by evaluating these high dollar claim expenses before a plan member’s utilization of a medical service or procedure.
Fully accredited by the Utilization Review Accreditation Commission (URAC), our program also provides concurrent and retrospective reviews as well as discharge planning.
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