University HealthSystem Consortium has formed a strategic partnership with Executive Health Resources, Inc., that will make the medical management company's Physician Advisor compliance, consulting, and auditing programs available to all UHC members.
"This strategic partnership with EHR will offer UHC members not only specialized pricing, but also services that include customized improvement insights," said Tom Robertson, vice president, business strategies and tactics, UHC. "In essence, members will receive the added benefit of a specific plan for concurrent medical necessity compliance and denials management."
Under the agreement announced today, Oak Brook, IL-based UHC's 107 academic medical centers and 220 affiliate hospitals can use EHR's programs, which include Concurrent Medicare Medical Necessity Compliance, Medicaid Medical Necessity Compliance, Retrospective Governmental Payor Appeals Solutions (including Comprehensive RAC, MAC, MIC, and QIO denial management), Managed Care/Commercial Payor Appeals, and Expert Advisory Services.
UHC and EHR will also analyze hospitals' member-level data to identify areas for improvement and customize plans for medical necessity compliance and denials management services. EHR will provide on-site implementation programs to educate case management staff on using EHR services.
Newtown Square, PA-based EHR, which works with more than 900 hospitals and health systems across the nation, said its Physician Advisors have successfully performed more than 1.2 million medical necessity reviews, conducted hundreds of audits at hospitals, and identified and reversed thousands of RAC medical necessity denials at all levels of appeal.