• Utilization Management

Clinically Aligned Status Decisions. Financially Sound Outcomes.

Reduce administrative burden and avoid costly missteps with a utilization management strategy built for speed, precision, and alignment.

  • 23% Average Payment Increase per Medical Case
  • 40% Fewer Physician Advisor Concurrent Reviews
  • 60% Reduction in Concurrent Patient Status Reviews
  • 50% Decrease in Observation Rates
UTILIZATION MANAGEMENT

Leveraging advanced data analytics with clinical expertise to strategically and compliantly combat payer denials

Physician Advisory

Strategic and programmatic approach to transform team performance

Analytics as a Service

Align critical metrics to your revenue goals

Admission Status Reviews

Proprietary data-driven review program to optimize patient admission status

Peer-to-Peer Reviews

We defend your patient care choices to secure fair reimbursement

Denials Management

Root-cause analysis and strategy to combat payer tactics

UM Resources

Payers Are Not Making Mistakes. Is Your Strategy Keeping Up?

Payers Are Not Making Mistakes. Is Your Strategy Keeping Up?

Payers Are Not Making Mistakes. Is Your Strategy Keeping Up? Hospitals and health systems are losing money on claims they believed were billed correctly. A claim comes back lower. The case lands on a downgraded DRG. The gap disappears into a pattern that continues to...

Regulatory Insights

Navigating CMS Price Transparency: What Hospitals Need to Know in 2025

Navigating CMS Price Transparency: What Hospitals Need to Know in 2025

Price Transparency in 2025: What’s Required, What’s Coming, What to Do Now  July 16, 2025, 11:00 AM PST Hospitals are facing mounting expectations around price transparency. But shifting regulations, incomplete guidance, and technical complexity make compliance a...

Regulatory Bulletins

Regulatory Bulletin: November 2025 WISeR Model

WISeR (Wasteful and Inappropriate Service Reduction) Model November 2025 Overview CMS has the responsibility to protect the Medicare Trust Funds, and routinely analyzes data associated with all facets of the Medicare program. A 2020 analysis of claims submitted by...

CMS Final Rule 2026: IPPS & LTCH PPS Updates (CMS-1833-F)

CMS Fiscal Year 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule CMS-1833-F Overview On July 31, 2025 CMS released the Fiscal Year 2026 Hospital Inpatient Prospective Payment System...