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Key Advantages

Delphi’s Utilization Review Program (UR) starts where other utilization review (UR) companies end. Most UR companies determine medical necessity and the cases are then closed. Here are a few key aspects of Delphi’s program that are unique:

1. We talk with the patient. Most UR companies deal almost exclusively with the physician’s nurses. The advantage is that we develop a rapport with the patient from the very beginning of their care. If we need to change the direction of the care, we already have a relationship and level of trust with the patient.
2. We look beyond the procedure. We not only look at the medical necessity, but also the continuance of care. We track the patient with any follow up work that needs to be done. We communicate with the patient about medical background and overall health status. The benefit is that we try to avoid lapses and conflicts with other care they are obtaining or not obtaining. Coordination of care saves money.
3. We negotiate better rates. If the procedure is non-par or out-of-network, we negotiate rates before the procedure is done. Delphi has found that negotiating rates after a procedure is performed has much less success.
4. We look for alternative treatments. Because we often work directly with the patient, we can suggest alternative procedures and test that might more efficiently diagnose and/or treat an employee’s ailment.
5. We identify large cases earlier. We initiate Large Case Management “LCM” at the precertification stage. The early discovery of potential LCM cases allow us to get involved prior to treatment patterns and clinical modalities are established and written in stone. Because we talk with the patient and have established rapport, we can effectively suggest other directions and alternatives with the attending physicians.
6. We are directly connected to claims file data. Delphi’s precertification authorizations, along with qualifying notes, are entered directly in to the claims file information. The benefit is that the claims processor doesn’t have to guess what is actually authorized. While other UR companies give blanket authorizations, we are very specific in our authorizations and even pre-price the claims when possible. As an example, if we are authorizing an MRI on an elbow, but get back an MRI claim with an elbow and wrist, the claims processor will know the wrist portion of the claim is unauthorized, and take action that saves money.

Delphi’s Medical Management Program is completely confidential and follow the guidelines for HIPAA compliance and of the Federal Government’s and State of Florida’s rules and regulations regarding confidentiality.