Managed Care Payer Solutions

Pre Authorization & Utilization Management

 

 

DRG CLAIMS Auditing & Management

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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.

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.

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Our DRGClaims division has unsurpassed expertise in identifying, correcting, and obtaining verified changes to DRG coding errors.  We have expanded our professional services at the request of our clients including the development of our  unprecedented and customized pre-payment DRG auditing program.

We value our clients by providing superior client service and support, and deliver results that exceed expectations and industry standards.   Ensuring DRG Claims compliance and integrity with provider-verified audit results with a customized service model for managed care payers.

Our clinical and business leadership brings decades of experience in cost containment in every payer-based and managed care setting.

The cornerstone of our success in resolving DRG coding errors and ensuring a smooth recovery process is our commitment to delivering an appeal-safe process.