Making Better UR Decisions at the Desk Level
WAYNE, PA – April 6, 2016 – Genex Services recently enhanced its Utilization Review (UR) Services with the addition of an automated approval software-as-a-service (SaaS) platform. The advancement allows companies to bring their overall medical strategy to every desk for improved decision-making and delivery of appropriate care for injured workers.
The solution pairs Genex’s automated technology with physician-only review and seamlessly integrates with case management, bill review, and pharmacy benefit management to give payers greater control of care for injured workers and medical spend.
The science behind Genex’s Utilization Services is a best-of-breed software platform with configurable processes that ensure appropriate, consistent decisions on all requests for authorization. Genex is streamlining workflows and virtually eliminating the internal administrative burdens inherent in the UR process. With adjusters carrying overwhelming caseloads with numerous time-sensitive medical requests per month, Genex saves adjusters considerable time by automating these requests.
Also, in a recent review of 50,000 medical services for a large carrier, Genex found 26 percent of the requested medical services fell outside of evidence-based guidelines representing a potential savings of $1.5 million. Genex’s proprietary software platform leverages industry-standard and proprietary evidence-based guidelines on every request for authorization, improving the consistency and quality of decision-making.
“This is another great example of how Genex brings together the heart and science of medical management,” said Cathy Glade, senior vice president of Utilization Management Services. “Utilizing our highly-specialized technology, physician expertise, and evidence-based guidelines on every claim ensures injured workers receive the right care in the right way. It is also crucial that this care is delivered in a timely manner to avoid delays in treatment and return to work. Genex provides these treatment recommendations significantly faster than state requirements. This alleviates payers’ risks of non-compliance and inappropriate care delivery, which also contributes to cost escalation.”
About Genex Services, LLC
Genex Services (www.genexservices.com) is the trusted provider of managed care services enabling workers’ compensation payers and risk managers to transform their bottom lines. Genex is a managed care leader with more than 2,900 employees and 47 service locations throughout North America. The company serves 381 of the Fortune 500 companies as well as the top workers’ compensation and disability carriers and third-party administrators in the U.S. In addition, Genex is the only company that delivers high-quality clinical services enhanced by intelligent systems and 360-degree data analysis. The company consistently drives superior results related to medical, wage-loss, and productivity costs associated with claims in the workers’ compensation, disability, health care and automobile systems.