Helping Your Plan Provide Quality, Cost Effective Care
Our Care Review Utilization Management Program, which works in coordination with American Health Holding (AHH), is designed to help your employees better understand their proposed medical treatment and the alternatives. By acting as a patient advocate, we evaluate the appropriateness of hospital admissions and proposed lengths-of-stay, thereby reducing unnecessary claims costs and monitoring the quality of care.

Trained medical personnel are supported by clinical logic technology that uses nationally accepted medical criteria and standards to evaluate individual cases. By using nationally recognized protocols and treatment patterns, we are able to perform accurate and timely medical necessity reviews.

Clients benefit from the on-site integration of plan administration and utilization management through data availability, control of individual cases and close communication with the claims staff. Care Review utilizes a comprehensive, practicing, Board-Certified physician panel to assure physician-to-physician discussions when necessary.

The Care Review Utilization Management Program includes Medical, Surgical, Mental Health and Chemical Dependency Admission Review, Continued Stay Review, Case Management Screening and Discharge Planning. Care Review puts PBA in a position to do a better job of obtaining discounted fees for Durable Medical Equipment (DME), ancillary therapies and other treatment upon hospital discharge or after outpatient surgery.

Care Review is an URAC accredited program licensed in all states and our professional staff is certified in both case management and utilization review.