Utilization Review User Guide - CPSI Application Documentation

Introduction 1Chapter 1Introduction1.1 OverviewThe Utilization Review module automates hospital-wide total quality management and reportingrequirements for a truly powerful and flexible program. The Infection Control module operatesconcurrently with immediate access to the fully integrated system database, automatically trackingutilization by procedure, diagnosis, physician, order status, pharmacy profile, test results andclinical history.Features· Touch screen application· User-defined criteria· Criteria based on patient’s financial class· User defined informational help screens by intermediary· Admission, concurrent, and retrospective review capabilities· Accommodates review on all patient types· Financial class-specific denial letters· Reviewer-specific cases· Case management reporting· Database capabilitiesNOTE: CPSI Clinical software is being converted to new maps. Some of these new maps may beseen throughout this User Guide. When new maps are released for an application, CPSI will addthose new maps to the next set of manuals that are published.1.2 What's NewThis section introduces the new features and improvements for the Utilization Review application for Version16. A brief summary of each enhancement is given referencing its particular location if applicable.Each enhancement also includes the Work Request Number (WR) and a short description. If furtherinformation is needed, please contact CPSI Clinical support.NOTE: There are no new enhancements for this User Guide for release Version 16.© 2009 Computer Programs and Systems, Inc.