Utilization Review and Peer Review Services

An effective utilization management program is more important than ever for efficient health care operations. Prevent claim denials and deliver the right care at the right time with independent utilization and peer review services.

Utilization Review Services

Utilization review (UR) can relieve some of the pressure that hospitals face to contain costs while at the same time improving the quality of care. VCP leverages nationally recognized guidelines to ensure compliance while streamlining the review process, enabling faster turnaround times, and shortening the revenue cycle by working to reverse denials without long appeals.

Services

All VCP UR services are conducted in strict accordance with state-mandated guidelines and delivered by our in-house team of licensed and registered nurses under the clinical direction of our medical director.

• Prospective (preauthorization), concurrent, and retrospective reviews
• Pharmacy Utilization Review
• Evidence-based national guidelines or state-specific guidelines
• UR platform integrated with case management, discharge planning and bill review
• Internal appeals and resolution dispute services
• Quality assurance reviews to ensure effective resource management

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Clinical Peer Review Services

Our clinical peer review services involve an extensive review of the requester’s questions, associated medical records, and case-related information. Special focus is given to pre-existing conditions, co-morbidities and other clinically relevant factors.

Requests for in-depth peer-to peer evaluations of medical necessity and appropriateness of care are conducted by VCP’s panel of physician reviewers.

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