Keep every stay authorized, before a day is ever at risk.
Utilization review and authorization management for behavioral health: verification of benefits, day-by-day authorization coverage with billing-risk gaps surfaced early, and continued-stay justification drawn from the record.
The authorization runway, watched day by day.
Each admitted day is checked against the authorization for the level of care in effect. As the runway thins, the concurrent review is already a task, so the gap that would cost you a day of revenue never opens.
Each admitted day is checked against the authorization on file for the level of care in effect. A gap is a billing-risk day, the review is due before one can open, so the stay never lapses.
The whole authorization picture, in one place.
Every admitted day as covered, authorized runway, or a billing-risk gap, the authorization history with what is exhausted or denied, and a payer communication log of every peer-to-peer, denial, and review, so the case for the next appeal is already assembled.
Peer-to-peer with the payer's medical director, presented ASAM dimensional ratings and continued-stay rationale, decision pending.
United Healthcare denied continued stay at Residential (3.5), medical necessity questioned. Peer-to-peer requested.
Concurrent review with United Healthcare for Residential (3.5), continued stay supported, approved through Sep 26.
Authorizations, reviews, and appeals are recorded on the patient chart.
Day-by-day authorization coverage
Every admitted day is checked against the authorization on file for the level of care in effect that day. Covered days and any gaps show on one strip, and a gap is a billing-risk day, surfaced while there’s still time to close it, not discovered on a denied claim.
Concurrent reviews as tasks
A review coming due isn’t a date on a spreadsheet someone has to remember, it’s a task, routed to your utilization-review team automatically as the runway thins. The stay stays authorized because the next review is already on someone’s worklist.
Continued-stay justification from the record
The justification is drawn from the chart you already keep, standardized-measure trends, which plan objectives remain unmet, and the multidimensional risk picture, assembled into medical-necessity language. You review and edit it; you never write it from a blank page.
Benefits verified up front
Verification of benefits feeds coverage and authorization from the start, so the level of care you admit to is the one the plan actually covers, and the authorization clock starts against real benefits, not an assumption.
Scoped reviewer access, not a faxed chart
Grant a payer or UR reviewer time-boxed, consent-gated access to exactly the records a review needs, with every view written to a disclosure log. It replaces faxing pages of a Part 2 chart to an outside reviewer with something you can actually account for.
Payer performance in the open
See how each payer actually performs on authorizations, reviews, and outcomes. When a plan denies more or reviews slower than its peers, you negotiate and staff from data instead of a hunch.
Common questions
What is “day-by-day authorization coverage”?
Rather than storing an authorization as a single number in a field, vPro EMR checks each admitted day against the authorization on file for the level of care in effect that day. The result is a coverage strip that shows covered days and any gaps. A gap is a billing-risk day, a day of care delivered without an authorization behind it, surfaced early so you can close it with a concurrent or retrospective review before it becomes a denial.
How do concurrent reviews reach my UR team?
Automatically, as tasks. As an authorization’s runway thins, the review that keeps the stay authorized is materialized onto the utilization-review worklist, routed to the UR role, not left for someone to catch on a spreadsheet. Turning the review into an owned, dated task is what keeps a stay from lapsing between authorizations.
Where does the continued-stay justification come from?
From the record you already keep. vPro EMR draws the justification from standardized-measure trends, the plan objectives that remain unmet, and the multidimensional risk assessment, and assembles them into medical-necessity language for the level of care in effect. It is a draft grounded in the chart, you review and edit it before it goes to the payer, and it is never fabricated or submitted on its own.
How do outside reviewers get the records they need?
Through vPro Exchange: you grant a specific payer or UR reviewer scoped, time-boxed, consent-gated access to exactly the records under review, and every access is written to a disclosure log. For a 42 CFR Part 2 record that accountability is the point, it replaces faxing a chart out into a fax machine you can never audit again.
Does verification of benefits connect to authorizations?
Yes. Verification of benefits feeds coverage and authorization from intake forward, so the level of care you admit to is one the plan covers and the authorization is tracked against real benefits. Coverage, VOB, and the authorization runway are one continuous workflow, not three disconnected screens.
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