Utilization Management
What We can do for you
Focus Your Time on What Matters Most
Ensuring Patients Get the Care They Need
Utilization management makes sure patients receive necessary treatments while reducing unnecessary healthcare costs and waste.
Maximize Insurance Coverage
Our utilization management focuses on maximizing what insurance will cover, avoiding unnecessary procedures to minimize costs.
Oversight by Certified Experts
Our team, led by ASAM-certified Specialists, ensures your services are coded correctly and covered by insurance for optimal results.
Admissions and Continued Stay Advocacy
We advocate for patients who need extended treatment, ensuring that they receive the necessary approvals and care.
Audits to Improve Clinical Documentation
We conduct audits to ensure your clinical documentation is effective, covering intensity, scheduling, and other key service details.
Help Implementing New Practices
If current practices aren’t meeting patient needs, we help implement new guidelines for maximum effectiveness and compliance.
Peer-to-Peer Review Process
Our physicians are available to counter any utilization review medical necessity issues that might arise during claims or appeals.
Devote More Resources to Patient Care
Our utilization management services help reduce administrative burdens, allowing more time and resources to focus on patient care.
Why Choose Us for Utilization Management Services?
Streamline Patient Care While Cutting Costs and Unnecessary Steps
Ensure your patients receive the necessary care without the burden of unnecessary procedures. Our utilization management services focus on maximizing insurance coverage while reducing healthcare waste. By effectively managing authorizations and ensuring correct coding, we help minimize costs and improve patient outcomes.
Don’t compromise on patient care—let our experts handle utilization reviews and secure optimal coverage for your services.
Expert Utilization Review Services
Our certified team ensures that all services meet required criteria, preventing unnecessary procedures and maximizing efficiency while ensuring patients receive the treatment they need.
Optimized Patient Advocacy & Clinical Documentation
We advocate for your patients during their treatment, ensuring they get appropriate approvals, while also auditing your clinical documentation to optimize compliance and maximize reimbursements.
(818) 600-4146
Utilization Management in Behavioral Healthcare: Frequently Asked Questions
The three assessments are prospective review (before treatment begins), concurrent review (during active treatment), and retrospective review (after services are delivered). In behavioral health, concurrent review is the most resource-intensive because it drives daily authorization decisions across each level of care.
The main types are prior authorization, concurrent review, retrospective review, peer-to-peer review, and discharge planning. Behavioral health facilities use all five regularly because payers require continued-stay authorization at every level of care, from detox through outpatient.
Improve utilization management by standardizing ASAM criteria application, training clinical staff on documentation that supports medical necessity, conducting internal audits before submissions, and using peer-to-peer reviews proactively. CodeMax supports each of these through ASAM-certified specialists and clinical documentation audits.
The Level of Care Utilization System (LOCUS) is a clinical tool that determines the appropriate intensity of behavioral health services based on risk, functioning, and treatment needs. Payers use LOCUS alongside ASAM criteria to authorize and deny continued-stay requests in residential and inpatient settings.
ASAM Level 2.5 is partial hospitalization (PHP), an intensive structured treatment program providing 20 or more hours of clinical services per week without overnight stay. It sits between intensive outpatient (Level 2.1) and residential treatment (Level 3) on the ASAM continuum of care.
