Concurrent Review Console

The Concurrent Review Console gives Utilization Review (UR) nurses and case managers a single pane of glass to manage active payer reviews. It synchronizes real-time payer updates, clinical criteria validation, and communication threads, reducing fragmented workflows and missed deadlines that can lead to denials.

Users can view review clocks, attach required documentation, capture InterQual or MCG findings, and log payer communications directly in the EMR context. The result is faster determinations, better alignment with payer requirements, and a complete audit trail for appeals and compliance teams.

Benefits

• Faster determinations: Eliminates fragmented handoffs and reduces time between submission and payer response.
• Fewer preventable denials: Tracks criteria and timing automatically, ensuring no missed intervals or incomplete documentation.
• Defensible documentation: Captures clinical rationale, payer responses, and attachments in a single, timestamped view.
• Operational visibility: Displays live review counts, pending cases, and turnaround trends across payers and units.

Key Capabilities

• Review timeline & clocks: Tracks elapsed review time, submission deadlines, and response SLAs for concurrent cases.
• Clinical criteria capture: Links directly to InterQual or MCG findings, allowing quick “met/not met” notation and attachment of supporting documents.
• Structured communication log: Captures all payer contacts, calls, chats, emails, with timestamps and note categorization for traceability.
• Attachment & evidence management: Packages required documents, faxes, and summaries for submission directly from the console.
• Audit-ready export: Generates PDF or FHIR-based summaries for appeal preparation or internal review.
• Integration with status & authorization consoles: Maintains continuity with admission status, 278 transactions, and prior auth tracking.
• Performance dashboard: Provides real-time insight into turnaround times, payer performance, and concurrent review backlogs.

Great for

• Utilization Review Nurses and Case Managers: Manage real-time payer reviews with unified access to status, criteria findings, and communication logs, supporting timely determinations and audit-ready documentation.
• Health Information Management (HIM) and Revenue Integrity Teams: Reduce preventable denials and strengthen compliance posture through structured review clocks, InterQual/MCG capture links, and appeal-ready documentation workflows.
• Clinical Informatics and EMR Analysts: Govern concurrent review logic, monitor timing fidelity, and surface documentation gaps using dashboard overlays and payer response metrics.
• Payer Relations and Compliance Officers: Gain visibility into turnaround trends and criteria alignment for proactive denial prevention and policy negotiation.