Utilization Management

MedSolutions is dedicated to patient care, ensuring that each patient receives the best, most appropriate care possible while managing health care costs in the most efficient and effective manner.

Experts estimate that as many as half of the imaging studies currently performed in America do not fulfill the basic diagnostic need of altering or supporting the patient’s diagnosis. Our Utilization Management program seeks to help healthplans increase the effectiveness of every imaging study.

MedSolutions’ UM process is interactive and cooperative. Our extensive staff of knowledgeable medical professionals evaluates the quality and effectiveness of each requested study, in the best interest of the patient. Our program works to alter physician behavior through quality standards, self-referral controls, and physician education.

At the heart of MedSolutions’ approach to imaging management are information and cooperation: forging a close working relationship with referring physicians and helping them understand and pursue the most appropriate radiologic tests for clinical conditions presented. This is done through our state-of-the-art, evidence-based clinical guidelines.

At the same time, we improve interaction between health plans and physician groups through the sharing of information and the application of key management tools.

MedSolutions’ Utilization Management Service Center is accessible through phone, fax, or Internet. MedSolutions has the capability of conducting the entire program via the Internet, through our portal, MedSolutions Online).

Maintaining Quality Standards
MedSolutions strives to deliver quality programs to those who access and purchase our products and services. The Quality Management Program establishes standards that encompass all quality management activities and is an integral component in the delivery of all MedSolutions services.

URAC Accreditation and NCQA Compliance
MedSolutions has been granted a full, two-year quality accreditation for its health utilization management program issued by the American Accreditation HealthCare Commission/URAC, and when client healthplans have been reviewed by NCQA, our program has been found to be in full compliance with NCQA recommendations.

To intensify our focus on the delivery of quality services, MedSolutions created the Quality Management Committee, composed of representatives from all operational areas. This team oversees and promotes the development, implementation, and evaluation of programs in an effort to continuously improve the quality of care and service for our customers throughout the operational divisions.

MedSolutions has also created a Utilization Management Committee which is responsible for the development, implementation, and evaluation of programs designed to continuously improve the quality of care and service delivered by the Utilization Management Department. This group of medical management leaders annually evaluate MedSolutions' utilization management program activities, and approve action plans for continuous quality improvement. They also review  

• clinical and non-clinical inter-rater audit reports

• medical necessity decision summaries, initial review and appeal decisions

• medical necessity decision turnaround time summary reports

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