Utilization Review External Access

The Utilization Review External functionality allows your organization to authorize representatives from insurance providers to review specific patients, chart tabs, and related forms. 

Super Admins can set up the system and provision external users. Only after the feature is fully set up and the access is cleared, should you provide credentials to the insurance representative. 

The process for setting up UR External Review includes: 

1. Designate which patient chart tabs contain relevant documentation.
2. Choose which patient charts can be accessed for external review.
3. Select which Consent and Evaluation forms are relevant for external reviewers.
4. Create Utilization Review External user profiles. 

Designate Chart Tabs

Super Admins must designate which chart tabs contain relevant UR documentation in Settings > Patients > Patient Processes. Only tabs selected will be viewable by UR External users.

1. Click on your initials and select Settings. 
   
2. Open the Patients tab. This tab can be titled differently depending on your Instance settings, e.g., Clients or Residents, however, it's always the first tab under Settings
3. Scroll to the Processes, Medication, Treatment Plans, Diagnoses section. Tip: Use Ctrl + F (Windows) or Cmd + F (Mac) to search on the page.
4. Check Allow UR for each tab you want to be viewable by UR External users.
5. Click Update.

Choose Patients

Users with Manage Utilization Review feature added to their profile can select what charts the UR External user can access:

1. Locate the patient and click Edit Patient from the facesheet (Information tab).
2. Check Allow UR (this checkbox is located under the patient's MR Number).
3. Repeat this process to provision additional patients for UR External access. 

Select Forms

Once you've selected the patient tabs and patients for UR External Review, you'll need to select each form within each patient chart that you want available for external review.

1. Locate the patient and open the tab containing the documents you'd like to make available for external review. 
2. Select the Allow UR checkbox for each form that should be viewable. 
   • If you don't see the Allow UR checkboxes for a specific tab, this indicates the tab doesn't have Allow UR selected in the Patient Processes settings.
3. Repeat this process for each tab and every patient you need the UR External user to review. 

Create Utilization Review External Users

Super Admins and users with the Manage Users feature can create Utilization Review External Users. Important: Do not combine this role with any other internal or external roles. 

1. Click on your initials and select Manage Users.
2. Click New to create a new user profile or edit an existing user profile.
3. At a minimum, add a first name, last name, and email address for the user.
4. Select at least one Location.
5. From the External roles section, select Utilization review external.
6. Click Register & Invite to create the user profile and invite the user to your EMR account.