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Utilization Management

Senior Asian Couple Adults with Medical Staff at Home

For more than 30 years, Health Services Advisory Group (HSAG) has been performing utilization review of health services to ensure that patients receive optimal medical care that is medically necessary and delivered in the appropriate setting. HSAG has extensive utilization management experience, having reviewed more than 300,000 medical and surgical cases for medical necessity, appropriate level of care, and coding accuracy. Clients include self-funded health plans and state agencies. 

HSAG’s utilization management services:

  • Include precertification as well as concurrent and retrospective case review.
  • Utilize national evidence-based guidelines to support clinical decision making, ensuring that the right care is delivered by the right provider, at the right time and in the right place. 
  • Feature first-level reviews by registered nurses, promoting an efficient process to facilitate timely and appropriate care and treatment.
  • Are supported by more than 300 board-certified physician advisors who are available to assist in determining medical necessity if the requests do not meet the criteria.
  • Include reconsideration, second opinion, peer-to-peer discussions, and appeals reviews for services that have been determined not medically necessary. 

A full range of reporting options is available as determined by the client’s need. For more information, please contact 602.801.6920.