PROVIDERS:
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Solutions
UTILIZATION MANAGEMENT
More than just verification of medical necessity

Pre-certification

Utilization Management is more than just verification of medical necessity... It is the Plan's front-line defense for providing their members with the best possible options for savings and quality of care!  With the assistance of an INETICO Nurse, health plans can better manage costs and improve clinical outcomes.

Concurrent
​Review

To submit a new precertification
authorization, please click here!

Physician Review

Discharge
​Planning

PRE-CERTIFICATION
Verification of medical necessity

Prospective
Review

Retrospective
Review

PROSPECTIVE REVIEW
Review of medical status & proposed procedures
CONCURRENT REVIEW
Ongoing review during inpatient hospitalization
DISCHARGE PLANNING
Ensures the best care after discharge
RETROSPECTIVE REVIEW
Post service reviews & negotiations
PHYSICIAN REVIEW
Unbiased, decisive, professional review services
INETICO RESULTS
INETICO's approach to Utlization Management has documented claims savings to help reduce overall health plan costs.  Using the INETICO Utlization Management program, our trained RN Case Managers help ensure the following:
Only patients with medical need for hospitalization are admitted
Proposed treatment
plan appropriate
​for the diagnosis

Inpatient stays
are necessary
​& appropriate

Diagnostic tests are in compliance with condition
Quality of treatment plan
​is evaluated