Utilization management is an essential service in order to ensure the proper delivery of medically appropriate and approved care.

Veritas’ clinical and medical experts perform prospective, concurrent and/or retrospective review designed to ensure that care is medically necessary and appropriate.

Our pre-payment prospective review helps providers reduce medically unnecessary admissions or procedures. We deliver insight and guidance that allows our clients to make educated decisions on whether to deny cases that do not meet specific criteria or assign these cases to care settings that are more appropriate for the patient and/or treatment prior to delivery of services.

Our concurrent review is performed as services are rendered, helping support decisions at the point of care. Through concurrent review, providers learn whether an insurance plan covers the treatment under review, reducing denials and cutting costs.

Our retrospective review evaluates whether the appropriate type of care, timing of care, and site for the care was achieved. We look at member eligibility and availability of benefits as well as analyze patient care data and supporting clinical documentation. Through retrospective review, providers and payers can identify whether patients receive the most appropriate care possible using the most appropriate type and amount of resources to achieve the best outcomes. With this information, our clients can bring about improvements that further optimize all of these areas, improving quality and reducing costs in the process.

Whether you are looking for review of a few cases a week or hundreds, for short- or long-term projects, Veritas has the team of professionals and trusted expertise to deliver the fast, accurate results you need. Contact us to learn more.

Note: Our team may be in a position to assist your organization with work related to but outside of the scope described above. Learn about how Veritas "Special Projects" deliver services tailored to meet specific job needs.