Utilization Review

Saving You Money in the Past, Present and Future

AMC Utilization Management services are designed to help clients save money at every stage of a claim, as well as to foster better control of medical care costs.  These reviews assure that medical care is evaluated for necessity, frequency and duration.  To ensure that payments are made in accordance with jurisdictional guidelines, reviews are conducted both prospectively and retrospectively. They include:

• Pre-Certification/Pre-Authorization reviews
• Reviews performed by AMC’s Medical Director and Specialty Peer Review Network
• Reviews based on national evidence-based treatment guidelines

 While utilization review is clearly focused on appropriateness and cost of care, AMC’s Utilization Review also helps managers:

• Identify medical care trends and costs
• Pinpoint and target cost drivers within your organization
• Manage your program and make improvements
• Enhance benchmarking procedures
• Improve quality control
• Generate timely management information in the formats and timeframes best suited to the organization and its goals