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Navigating Utilization Review

The Utilization Review tab allows you to view all previously completed utilization reviews for patients and create new ones.

1. Accessing the Utilization Tab

  1. On the left-hand navigation menu, scroll down.
  2. Click on the Utilization tab.

2. Viewing Past Utilization Reviews

The main Utilization screen displays a list of all completed utilization reviews. You can see details such as:

    • Patient Name
    • Insurance
    • Review Type
    • Review Date
    • Reviewer
    • Status
    • Service 
    • Date Range

3. Creating a New Utilization Review

To create a new review for a patient:

  1. Click the + New Review button located in the upper right-hand corner of the screen.
  2. A pop-up form will appear where you can enter all the details related to the utilization review. 

Filling Out the Review Details

Follow these steps to complete the form:

Field Category

Action

Patient Selection

Click the Patient dropdown and search for/select the patient.

Insurance

The patient's insurance information will automatically populate from their chart.

Status

Select the status of the utilization review (e.g., Active).

Review Date

This field will automatically populate with today's date.

Service Type

Choose whether the review is for a Level of Care or a specific Service.

Level of Care/Service

Select the specific Level of Care (e.g., Residential) or Service.

Number of Units

Enter the number of units approved for this review.

Authorization Number

Type in the authorization number. This number will automatically populate on any encounters that occur during the approved start and end dates.

Review Range Dates

Select the Approval Range Start Date and Approval Range End Date using the calendar picker.

Scheduled Dates

On the right-hand side, use the calendar to select the specific days you would like to schedule the patient for the approved units. The Available Units counter at the top will decrease as you select dates.

Provider

Select the provider from the dropdown menu.

Notes / Case Manager / Contact Information

Add any relevant notes, case manager, or contact information.

Next Review Date

Set the date for the next review (Due Date) using the calendar picker.

Loading Previous Information

  • If you are completing a subsequent review, you can click Load info from last review at the bottom of the form to quickly populate details from the patient's previous review.

Saving the Review

  1. Once all fields are complete, click the Save button in the bottom right-hand corner.
  2. The new utilization review will now appear in the Utilization tab, and the patient has been scheduled for the approved level of care on the selected dates