Used with our lauded RCM system explicitly designed for your profession, tracking authorizations is simple and easy. Utilization review is a vital step in the revenue cycle management process, and DENmaar’s RCM system is designed to make it simpler and more manageable. With our system, you can track authorizations easily and have all the information you require at your fingertips- this makes it easy to ensure that patients are getting the care they need and that providers are being paid for their services.

When we’re talking about consumption, we’re talking about avoiding overconsumption. Our behavioral health utilization management review process focuses on delivering the proper care to the right place. To make decisions about medical necessity, we consider the following factors:

• Patient characteristics such as symptom severity, the severity of psychosocial stress, previous treatment attempts, clinical diagnosis, and level of functional impairment
• Clinical outcomes research and clinical practice/level of care guidelines
• System and local provider capabilities

This process allows us to know where and how this patient can be most safely and effectively treated in an environment that promotes optimal performance.

Underutilization creates problems. When patients do not receive the care they initially need, they may relapse, require higher levels of treatment, or require medical leave because of a mental disability.

Our medically necessary treatment for mental health coverage and substance use disorders is provided under the same terms and conditions as other medical conditions. Our medically essential treatment for mental health or substance use disorder means a service or product designed to satisfy the patient’s specific needs to prevent, diagnose, or treat, including minimizing the development of the disease, injury, condition, or symptoms. We perform this based on the following criteria:

• According to general mental health care standards and substance use disorders
• Medically appropriate in terms of type, frequency, extent, site, and duration
• Primarily for the financial benefit of health care plans and members or the convenience of the patient, attending physician, or other health care provider.