[wincha]

I know this isn't officially case management however this appears to be the best place to post this.

I understand what UR is for insurance companies ie Interqual Guidelines to pay for a level of care or not in the hospital. My question is what UR nurses do working in the department for the hospital. I am assuming keeping track of what the insurance co will pay for, appealing, looking for more ways to get the insurance co to pay ect... any other tasks of UR in the hospital?

Thank you very much for whoever can answer this question.

[CaseManager]

UR in Acute Care Hospitals that I do is to call in or fax reviews on inpatients with a clinical update to Ins. Case Mangers for continued days to stay in our hospital. If it's a perdium with exclusions then you will need to let the CM of the Ins company know that patient is have a proceedure as they will be paying for this. If you get a % as 70 % then usually everything is included, but we have diferent contracts with co. also. Is that clear as mud? LOL! Also Ur is going through your chats everyday making sure the patient meets continued stay by your criteria. Hope this helps or is even wht you wanted!