Managed Care and Utilization Review Linked to Billing

Managed Care…Concurrent Utilization Review…Case Management. Different providers refer to it by different names, but the concept is the same. Coordinating the relationship between prior managed care authorization and billing for behavioral health facilities is more complex and requires more precision than in the acute care environment.

Communication between clinical staff and the Business Office is paramount, and Logik Solutions facilitates that communication. The Business Office and Case Managers are linked via the touch of a button to see each other’s work and get on with the business of both providing care managing patient accounts.

The Medik Managed Care module gives users tools to record the history of prior authorizations and service dates authorized. Users can track denials of service, the reasons for those denials, and all of the efforts undertaken during the appeals process.

Denial Log Reports, Certification Reports and follow-up “ticklers” aid the users in keeping up with the workload so individual admissions don’t fall through the cracks. Users can produce information about denials in process, including days and dollars denied, and track appeals through to resolution.

For Professional Fees, Medik tracks date spans authorized plus, specific services within that span. As services are provided, the authorization reflects not only the original volume of services authorized, but, the services consumed, and number remaining. Related reports and review screens allow the Business Office and the care providers to instantly evaluate what services were rendered and how many additional services are available.

Communication, integration and practical links between clinical case managers and finance is another reason Logik Solutions provides higher revenues per patient day.