BMS CareConnex™ Inpatient UR monitors and ensures quality, appropriate healthcare, while eliminating over-utilization of costly services and hospitalizations. Our Utilization Review department includes a Board Certified physician with over 10 years of managed care experience, Registered Nurses with an average of 19 years of utilization review experience, and access to over 100 independent physician consultants of every specialty and sub-specialty area. The BMS CareConnex™ Inpatient UR module is comprehensive in scope and includes pre-admission review, concurrent review, retrospective review, and discharge planning.

Evidence-based guidelines

A registered nurse performs a preadmission review for all scheduled hospital admissions to make sure that each admission is medically necessary (according to evidenced-based, industry standard guidelines such as Milliman) and also is provided in the most cost effective environment. Following the actual admission, a concurrent review process monitors the medical necessity of each subsequent inpatient day.

Fully integrated UR functions

Full integration with all other BMS CareConnex™ modules ensures continuity and consistency of member and physician communication, and further helps to control over-utilization. The Inpatient UR module also fully integrates with the BMS account management, claims, and customer service departments, providing a key advantage to the BMS CareConnex™ product versus other external UR vendors.