Inpatient services are often times the most costly patient care for which a health plan will be responsible. Affecting the status of a small number of these requests can result in big savings.
Pre-certification of many of these cases leads to approval based on inpatient-only procedure guidelines. Therefore, determining the appropriateness of an inpatient status for those other cases becomes that much more important.
Cadenza Health has a team of reviewers with a long history of clinical practice in the acute care setting. This makes us uniquely qualified to make the right decision based on medical necessity when guidelines are not available or do not apply to the situation at hand. Our understanding of acute care illness, pre- and post-operative surgical care and the utilization management process, including the challenges of inpatient service appeals, allows us to provide you with top quality results.