Goals of BHN’s UR Program are to assess treatment for:
- Medical necessity and appropriateness
- Treatment deficiencies
- Quality of care and positive outcomes
Key Features and Advantages:
- URAC Accreditation BHN has held URAC Accreditation in Health Utilization and Workers’ Compensation Utilization Management since 2000. The URAC Accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.
- UM Services are guided by BHN’s Quality Management Program, which sets the highest priority on timeliness, accuracy, quality of care and cost-effectiveness.
- Each initial review is conducted by a registered nurse reviewer who applies established care guidelines that meet national and community standards
- The reviewers interact with attending physicians to agree on treatment plans and appropriate lengths of stay. Cases are continually monitored throughout the hospital stay to assure quality and appropriateness of care
- Medical director and Panel of Specialists: leading the BHN UM Program is a board-certified Medical Director who oversees BHN’s full-spectrum of specialty physician panel
- Integration with case management services: BHN’s UM program utilizes Telephonic Case Managers to perform first-level review when assigned to their cases. This provides seamless, cost-effective management of claims. BHN’s Field Case Management program provides internal triggers to flag cases that may benefit from or require UM services.
- Multi-State UR licensure
BHN clients are assured that a team of healthcare professionals has assessed every case, and that the best alternatives for optimal, cost-effective treatment have been evaluated, recommended and monitored.