Utilization Management & Review Solutions (UR/UM)
ADEC Healthcare helps providers excel in Utilization Review, reduce resource strain, recover lost revenue, and boost Net Patient Revenue with specialized Clinical Revenue Cycle services. Receive actionable insights to help you scale operations smoothly.
Prosprective Review
Pre-service authorizations and eligibility checks managed before treatment begins.
Concurrent Review
Clinical review and admin support alongside hospital UM staff to keep decisions timely.
Retrospective Review
Post-discharge documentation checks, medical necessity validation, and payer discrepancy resolution.
THE CHALLENGE
Why utilization review strains care teams
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.
HOW IT WORKS
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.
INCLUDED SERVICES
Back-Office Support in UR/UM
Efficiency is not an upgrade. It’s essential. ADEC Healthcare makes it part of how you operate
We strengthen patient access through accurate registration, insurance capture, and financial clearance that prevent claim errors before they occur.
Learn MoreOur teams manage verification, submission, and payer follow-up to streamline approvals and secure timely reimbursement.
Learn MoreWe align clinical detail with coding accuracy to support compliance, medical necessity, and stronger financial outcomes.
Learn MoreADEC Healthcare delivers precise, compliant coding that ensures accurate reimbursement and clear reporting across all specialties.
Learn MoreADEC Healthcare delivers precise, compliant coding that ensures accurate reimbursement and clear reporting across all specialties.
Learn MoreOur specialists identify root causes of denials, resolve issues quickly, and build preventive processes that protect future revenue.
Learn MoreWe unify documentation, coding, and billing workflows to eliminate revenue leakage and improve financial transparency.
Learn MoreOur A/R teams accelerate collections, streamline payment posting, and reconcile balances to improve cash flow and shorten settlement times.
Learn MoreIntake 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
THE OUTCOME
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