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Our utilization review program provides pre-authorization and medical necessity reviews that ensure members receive appropriate care while addressing opportunities for cost savings.
Narus Health’s utilization management is monitored to ensure that the care your employees receive is appropriate and of the best quality. All admission evaluations and reviews are conducted by registered nurses with an average of 10 or more years of clinical experience or by board-certified physicians. We also help the member understand the services covered within their health benefit and make referrals to case management to ensure the member is supported throughout their medical journey. Our exceptional utilization review program develops guidelines for your company to ensure that physicians, labs, and facilities are administering the appropriate care for each condition.
Our Specialty Care Review program offers a more comprehensive set of services to evaluate the value and appropriateness of newer, high-cost testing and procedures. Some newer methods of treatment can lack medical effectiveness, resulting in unwarranted costs for both you and your employees. These treatments may include genetic testing, expensive lab testing used in substance abuse programs, specialty pharma, and high-cost drugs.
These reviews support the member in understanding what is covered within their benefit design and evaluate whether the service is an appropriate standard of care or experimental.