Three Phases of Smarter Utilization Review
ADEC Healthcare delivers utilization review and management as a coordinated global operation. Our model connects clinical reviewers, data analysts, and administrative specialists across regions, ensuring every phase of the review process runs efficiently, accurately, and in full alignment with your internal care teams.
Prospective Review
We manage pre-service authorizations and eligibility checks before treatment begins. Our global model reduces turnaround time, strengthens payer alignment, and helps prevent costly denials.
Concurrent Review
Our teams work alongside hospital utilization management staff to provide the clinical review and administrative support that keep decisions consistent and timely.
Retrospective Review
After discharge, we complete documentation checks, validate medical necessity, and resolve payer discrepancies to close each case accurately and on schedule.
Improve Turnaround. Reduce Friction. Protect Revenue.
Our solutions are designed to integrate seamlessly with your current systems, minimizing disruptions and avoiding major tech changes or extensive staff training.
- 100%Utilization Managment Reviewers (UMR)
- Experienced PHRNs and USRNs
- Proprietary workflow applications
- Performance Management
- Team engagement activities
- Metrics and Reporting to the Client
Looking to Strengthen Your UM Operations?
Benefits of ADEC Healthcare UR/UM
Improved Clinical Confidence
Care decisions stay aligned with evidence-based medical necessity, reducing uncertainty and back-and-forth review.
Higher Authorization Success Rates
Cleaner documentation and request management result in fewer delays and more first-pass approvals.
Reduced Denial Volume
Preventive review lowers the number of avoidable denials that create rework and cashflow disruption.
Faster Payer Response
Proactive communication and follow-up help shorten the time between request, review, and payer decision.
Stabilized Workload and Staffing
Labor arbitrage ensures routine review volume is handled consistently, reducing burnout and internal turnover pressure.
Predictable Financial Performance
A steadier authorization and billing path supports smoother revenue capture and more reliable reimbursement timelines.
Back-Office Support in UR/UM
Efficiency is not an upgrade. It’s essential. ADEC Healthcare makes it part of how you operate
Intake and Case Preparation
UR/UM begins with accurate setup. Our teams collect and organize all required documentation, confirm benefits, and create structured cases that move smoothly through review.
- Request intake and case creation in the UM platform
- Documentation gathering (clinical notes, orders, imaging, labs)
- Eligibility and benefit verification tied to payer requirements
Review Support and Clinical Coordination
We support the clinical decision process by preparing cases with complete, clearly organized information. This ensures reviewers have what they need and escalations happen only when necessary.
- Criteria pre-screening using InterQual or MCG guidance
- Case routing to the correct review level (standard, RN, MD)
- Communication with providers and facilities for missing information
Determination and Follow Up
Once a decision is made, timely communication protects continuity of care and revenue integrity. We track status, prepare determination notices, and ensure systems stay accurate and aligned.
- Status tracking and payer follow-up to prevent delays
- Preparation of determination notices and appeal packets
- Updating UM systems, EHRs, and audit logs for complete record accuracy