Health System & Hospital Utilization Management

Industry-leading revenue integrity solutions backed by clinical expertise and artificial intelligence.

Health System & Hospital Utilization Management

Industry-leading revenue integrity solutions backed by clinical expertise and artificial intelligence.

Ensure High-Quality Patient Care While Increasing Revenue

Utilization management ensures that your patients receive the highest level of care possible from your clinical team while decreasing denials and increasing your clean claim submission rate. Advent Health Partners works as part of your team to complete more utilization management reviews, reinforcing your organization’s denial prevention strategy and letting your clinical team do what they do best: patient care. Advent’s data-driven approach can reduce your organization’s rising costs with detailed claim review—we are able to identify mistakes in missing medical necessity documentation or errors in coding and billing. Learn more about our utilization management solutions below.

Implementing Utilization Management

Prior Authorizations

Prior authorizations, also known as prospective reviews, improve patient access while assisting hospitals by decreasing the number of claim denials. Advent’s clinical expertise and payer knowledge are able to determine whether care is medically necessary and covered.

Concurrent Reviews

Delegating concurrent reviews to a clinically experienced partner—whether in whole or part—relieves pressure on nursing staff while maximizing financial benefits. Advent Health Partners steps into your team’s existing workflow to perform concurrent reviews in real-time through EMR access for emergency department or inpatient cases.

Pre-Bill Reviews

Pre-bill reviews, also known as retrospective reviews, assess a patient’s treatment after completion to increase the chance of submitting a clean claim. Engaging Advent Health Partners’ team of clinical and coding experts in an organization’s pre-bill review process can help prevent denials, receive accurate reimbursement more quickly, and reduce operating costs.

Appeal & Claim Technology

Apello™ is Advent Health Partners’ technology platform that streamlines the claim review process by combining AI with aggregated decision data. Apello was designed for appeal and claims reviews to reduce administrative costs and decrease time to revenue. Apello enables utilization management teams to easily increase their total volume of reviews from the beginning to the end of a claim’s life. It is also used by Advent’s team of reviewers, enabling them to quickly and cost-effectively increase our partners’ clean claim rates.

Appeal & Claim Technology

Apello™ is Advent Health Partners’ technology platform that streamlines the claim review process by combining AI with aggregated decision data. Apello was designed for appeal and claims reviews to reduce administrative costs and decrease time to revenue. Apello enables UM teams to easily increase their total volume of reviews from the beginning to the end of a claim’s life. It is also used by Advent’s team of reviewers, enabling them to quickly and cost-effectively increase our partners’ clean claim rates.

Article Series

Optimizing Your Revenue Cycle

Advent Health Partners’ experts outline strategies to implement utilization management in your organization in this article series. Learn about best practices and recommendations to begin reaping the benefits of utilization management, such as reduced healthcare costs and increased patient satisfaction.

Why Use Advent for Utilization Management?

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Flexible Partnership

Advent can accommodate specific times, days, or review types to eliminate gaps in nurse reviewer coverage.

Immediate Expert Support

Our team steps into your existing workflow, ready to start immediately. We’re experts in the use of both InterQual® and Milliman Care Guidelines (MCG).

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Comprehensive Defense

In the unlikely event of a denial, Advent defends our work throughout the life of the claim – at no additional cost.

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Advent Health Partners Nurse Spotlight

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Michelle Ray, RN - Senior Nurse Auditor

Advent’s clinical team is comprised of experienced nurses that ensure a comprehensive level of service based on your organization’s individual needs. One of these nurses is Michelle Ray, RN, who, as a child, decided to become a nurse with the dream of helping people. After doing that in a hospital emergency department for several years, she transitioned to Advent Health Partners. One of her favorite things about her position as a Senior Nurse Auditor is being able to follow a patient from admission to discharge, ensuring that proper care is taken. Michelle handles Utilization Management for various partners and enjoys helping organizations solve challenges and increase their level of care.

Get in touch to discover how Advent Health Partners can help your organization tackle its business challenges.

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