Commercial insurers need a utilization review department making the right decisions on coverage, medical necessity and administrative determinations.
It can be difficult to find physician reviewers with a broad medical knowledge base who also have an extensive background in utilization management. You must have both in order to make appropriate decisions for your customers and your bottom line.
Cadenza Health has an experienced team of physicians with the medical knowledge needed to make determinations in all aspects of patient care. We have a comfortable grasp on Medicare-based and organizational coverage determination policies and how to apply them.
Whether it's pre-certification of DME or home health, concurrent inpatient/observation determinations or post-decision appeals, our team works daily on every type of review your organization will encounter. Our insight into this utilization process can help your team raise the bar.