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