Preauthorization & Utilization Management

Our Preauthorization & Utilization Management

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SFUR is a national URAC accredited Independent Review Organization that has been leveraging medical knowledge for over 30 years.   SFUR’s six hundred strong physician panel provides Utilization Review, Utilization Management (UR/UM), Peer Review and an array of various Cost Containment Solutions to health plans and insurance companies.


SFUR is URAC Accredited,  the highest standard in the industry.  We employ over 600 board certified Physician Specialists who we credential to the highest URAC standards every 2 years. Our clients count on our exceptional medical knowledge, impartial reporting and timely delivery.

Overview

Preauthorization & Utilization Management

The medical UR/UM component for Medicare Advantage, Managed Medicaid and other managed care plans is a critical function that requires medical depth, breadth and resourcefulness.  Members of SFUR’s physician panel have been providing UR/UM for  Medicare & Medicaid Managed plans in sixteen states for over five years.

The SFUR UR/UM physician panelists that specialize in various managed care plans provide decisions for Inpatient versus observation, authorization of expensive imaging services, authorization of durable medical equipment (DME), authorization of various surgical procedures, and numerous critical medical decisions affecting the managed care insured population.

Managed Care Clinical Criteria

  • Precertification, and preauthorization programs ensure that network doctors
    and hospitals provide the most appropriate and cost-effective care.
  • Clinical necessity and criteria help identify cases that may benefit from the assistance of various care management programs.
  • SFUR physician panelists that provide UR/UM are fluent in InterQual® clinical criteria for preauthorization of hospital admissions to determine the medical necessity of hospital admissions.
  • Peer Review is used to make final judgements about quality of care in many quality assurance activities.
  • To overcome the low reliability of Peer Review, input from several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability.
  • Our team of medical and financial professionals partner with insurance payers and legal firms to enhance their position to resolve complex billing and medical utilization disputes.

Services

  • SFUR is a proven and affordable source of 3rd party medical Peer Reviews.
  • Rapid turnaround
  • Board certified specialist
  • URAC Accredited Independent Review Organization means client benefits from standards.
  • All reports are vetted by a medical knowledge reviewer and signed by reviewing physician specialist.
  • Best Prices of the Certified Independent Review Organizations.

OUR PHYSICIAN SPECIALISTS

  • Anesthesia
  • Bariatric Surgery
  • Cardiology
  • Colon Rectal Surgery
  • Emergency Medicine
  • Family Practice
  • Gastroenterology
  • General Surgery
  • Hematology
  • Infectious Disease
  • Internal Medicine
  • Interventional Cardiology
  • Neonatology
  • Nephrology

 

  • Neurology
  • Neurosurgery
  • OBGYN
  • Ophthalmology
  • Orthopedic Surgery
  • Otolaryngology
  • Pediatrics
  • Plastic Surgery
  • Psychiatry
  • Pulmonology
  • Radiation Oncology
  • Thoracic Surgery
  • Urology
  • Vascular Surgery

Contact Us for more information or to schedule a consultation.