Utilization Management and Pre-Certification

“The Hines UR Team is ‘top-notch,’ gathering clinical data to determine medical necessity for the proposed treatment plan in a timely fashion. The ‘Team’ approach is what it is all about. I believe this is the philosophy with Hines & Associates and the direction for the future.”
—TPA Director of Cost Containment
Hines facilitates price concessions
Proven Results

Meet Mary

Mary, a three-year-old with hyperthyroidism, needed to achieve a normal state before a thyroidectomy could be safely performed. Preoperative days to administer potent medication were necessary to reduce thyroid function to normal, and could have affected her heart rate and bodily systems. Observation was necessary. Hines’ research facilitated a price concession. Sub-acute care rates were attained with admission to a monitored bed in the pediatric unit. Room and board rate were reduced by 75 percent.

The Result? Total Savings: $1,800.

Verifying Needs. Eliminating Concern.

The utilization review process begins with one call to the Hines’ toll-free number. Our goal? Simplify the system for the insured and all family members.

While doing this, Hines…

Telephone/Web Accessible

The insured, a family member, hospital representative or the doctor can precertify via either method. If notified of the confinement by a provider, Hines will contact the insured and/or family.

Instant, Accurate, Efficient Communication. Essential to Timely and Fair Claim Decisions.

Hines offers a variety of reports and delivery methods including direct-connect FTP services and anytime online reporting at no additional charge. Online, you can review precert and case management status as often as needed. If data is collected, we can report it.

Dedicated to healthcare education for over three decades, Hines’ door to communication is always open. Your questions receive a timely response!

For More Information:

See our Utilization/Pre-Certification PDF.