Medical Necessity Reviews & Case Management Solutions 2017-11-15T16:28:40+00:00

Conifer Utilization Reviews


Key Benefits

  • Achieve better quality and consistency in first level admission reviews
  • Improve coverage with real-time admission reviews 24 hours a day
  • Support better physician documentation
  • Reduce claim denials due to medical necessity

Seamless Extension of your Staff

Access InterQual® certified trainers and licensed nurse reviewers to augment your local resources. Real-time access to your clinical documentation enables our teams to provide admission review without disruption to your workflow.

Around-the-Clock Nurse Reviews

Eliminate any gaps in local coverage with our 24-hour a day, seven-day a week review service. Coverage includes weekends, nights and holidays.

Evidence-Based Decision Support

Our nurse reviewers are experts in the use of McKesson’s InterQual® level-of-care criteria to screen hospital admissions for medical necessity.

Real-Time Collaboration

Our workflow facilitates close coordination between our reviewers and your care management staff to improve communication with physicians and consistency in admission reviews.

Trend Reporting and Analysis

In addition to real-time reporting and interaction, we provide monthly reports that help identify physician and payer trends in admission, services ordered and reimbursement.

Offering Description

Conifer Utilization Reviews give you a faster, better way to help validate that patient admissions to your hospital meet clinical criteria. Our team of expert nurse reviewers consistently screen admissions for medical necessity and identify cases for second-level evaluation by physicians. Because our licensed nurse reviewers handle admission reviews accurately and efficiently, your local case managers have more time for direct patient interaction and care planning.

Related Resources

Conifer Utilization Reviews

Achieving timely review of admissions requires a staff of trained clinicians on hand, 24 hours a day.
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Conifer Clinical Revenue Integrity

The link between clinical quality and increased reimbursements: moving beyond ICD-10 preparation to creating a strategic revenue advantage.
View Page | Download PDF

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