Utilization Review

The KipuEMR conveniently stores and displays insurance information and a complete history of concurrent reviews on the Face Sheet in each patient’s chart.

Multiple insurance policy information may be added along with pictures of both the front and back of the primary insurance card.

Track insurance authorizations for services provided at each level of care, service date range, number of days, authorization date, number and status. Add Care Manager name, phone number and insurance company along with necessary comments.

The “Hx Level of Care” button enables quick access to a history of all levels of care assigned during the patients’ admission.

Utilization Reviews may be enabled for both internal and external Utilization Review

Vital Insurance information is stored on the Face Sheet, for easy access. Add multiple insurance policies and label according to “type of insurance” such a primary secondary, etc.… The “insurance type” list is configurable. ​Record concurrent reviews using a template built to store essential details, including a comment or note. Document Case Manager information: Name, Phone Number, Insurance Company and add a comment for later reference. Enable Utilization Review by external personnel by granting access to Kipu via the role “Utilization Review External” assigned in corresponding user profiles. Access will be limited and will allow review of charts that have been pre-approved by a two-step process that designates the client and individual documents, to be reviewed. External reviewers may also be granted access to certain tabs which will allow access to all documents housed under that tab.

Enter All Available Information:

  • Authorization date: Date that the authorization confirmation is received.
  • Number: Number of days or units of treatment (sessions) authorized.
  • Frequency: Select from custom drop-down options, set up in Settings/Patients.
  • Level of Care: Select from custom drop-down options, set up in Settings/Patients.
  • Start/End Dates: Date range that care is authorized.
  • Last Coverage Date: Select checkbox if the last date authorized is the same as the patient’s discharge date (end of the episode of care).
  • Authorization Number: Reference number provided by the Care Manager/Insurance Carrier.
  • Next Review Date: Date of the next review.
  • Insurance Company: Select from drop-down options (when patient has more than one insurance).
  • Comment: Enter any pertinent comment, for additional reference.

Utilization Review Internal Setting

To enable Utilization Review by an internal user, assign the role “Utilization Review Internal” or “Super Admin” in their user profile.