Medical Cost Containment
SFUR services the health insurance market including insurance companies, third party administrators, worker compensation carriers, self-insured ERISA plans, health plans, health maintenance organizations (HMOs), general liability carriers, auto accident carriers, life insurance carriers including death and disability, managed Medicare plans, managed Medicaid plans, Medicare, Medicaid. Our clinical and business leadership brings decades of experience in cost containment in every payer-based and managed care setting..
SFUR is a national URAC accredited Independent Review Organization that has been leveraging medical knowledge for over 30 years. SFUR’s six hundred strong physician panel provides utilization review, utilization management (UR/UM), peer review and an array of various cost containment solutions to health plans and insurance companies.
Members of SFUR’s physician panel have been providing UR/UM for Medicare & Medicaid Managed plans in sixteen states for over five years.
The SFUR UR/UM physician panelists that specialize in various managed care plans provide decisions for Inpatient versus observation, authorization of expensive imaging services, authorization of durable medical equipment (DME), authorization of various surgical procedures, and numerous critical medical decisions affecting the managed care insured population.
Our DRGClaims division has unsurpassed expertise in identifying, correcting, and obtaining verified changes to DRG coding errors. We have expanded our professional services at the request of our clients including the development of our unprecedented and customized pre-payment DRG auditing program. Ensuring DRG Claims compliance and integrity with provider-verified audit results with a customized service model for managed care payers.
We value our clients by providing superior client service and support, and deliver results that exceed expectations and industry standards.
We are confident that we provide our customers the best price with the highest quality results of all Certified Utilization Review Companies.
Health Insurance Cost Containment Solutions
SFUR defines medical cost containment as the process of leveraging medical and business knowledge to potentially lower the cost of medical bills.
We provide review, assessment and negotiation of medical cost, using a variety of methods which include, Separation of Charges, Coding Validation, Medical Necessity, State & Payer Specific Rules and Reasonable Charge Analysis.
SFUR is committed to improving the healthcare ecosystem. Both healthcare delivery participants and those entities that pay for healthcare, leverage the knowledge of the SFUR’s physician panelists. Monitoring compliance, fraud, waste and abuse starts with the SFUR physician panelists that can be impartial, objective and current in the knowledge and practice of their respective specialty.
The medical Utilization Review/Utilization Management (UR/UM) component for Medicare Advantage, Managed Medicaid and other managed care plans is a critical function that requires medical depth, breadth and resourcefulness. Members of SFUR’s physician panel have been providing Utilization Review for Medicare Advantage plans in thirty-two states for over ten years.