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Enlyte Utilization Review Solutions

Utilization Review, Delivered Your Way

Choose the operating model that fits your team, your jurisdictions, and how you want to balance access to care and cost control, then scale up or down as your business evolves.

Enlyte’s Utilization Review Solutions give workers’ compensation and auto payers a configurable utilization review program built to match how you run claims, then flexes as volume, complexity, and state requirements change. You can choose the model that best fits your needs: full service, SaaS, peer review, overflow or hybrid, and customize your rules and workflow based on your evolving managed care philosophy and business needs.

Key Metrics

$2M 

Annual Savings with Bill Review + UR Integration

43%

Prior Authorization Automated with UR + PBM Integration

163%

Increase in Surgery Savings by Implementing Expanded UR

Utilization Review Designed Around Your Business

Your jurisdictions, volume shifts, and risk tolerance are distinct. In this video, see how Enlyte helps you shape utilization review rules, workflows, staffing, and automation, then drive consistent enforcement and reporting across bill review and pharmacy, delivering a program that is customized to your needs.

 

Choose the Model That Best Fits Your Needs

 

Full Service Utilization Review

BEST FORFully outsourced utilization review operations with consistent, defensible decisions.

What You Get

We take complete ownership of the utilization review workflow. We receive requests, route each case to the right clinical reviewer, issue determinations and generate and deliver required documentation. You also get a dedicated service team that stays close to your program and desired outcomes.

Explore Full Service UR

Utilization Review Software Solution

BEST FORAn in-house team that needs a software solution that provides configurable rules and automation.

What You Get

An SaaS solution that is configurable to your workflows, rules, provides guideline support and visibility to run UR with confidence.

Explore SaaS UR

Physician Advisor and Peer Review

BEST FORA credentialed network of physicians to review appropriateness of utilization review requests at the initial or appeal stage.

What You Get

A large network of credentialed peer review physicians with broad specialty coverage.

Explore Peer Review

Overflow Utilization Review

BEST FORWhen you need capacity fast for spikes, backlogs or staffing gaps.

What You Get

Rapid support aligned to your rules, states and documentation standards.

Explore Overflow UR

Find Your Coverage

Click on the map to view state-specific information and how Enlyte can support.

 

Resources
 

   

Utilization Review Decision Manager (URDM)
Learn how URDM bridges the gap between utilization review and bill processing for better results.

Inside the Digital Shift of New York Workers’ Compensation
Explore the innovative digital transformation of New York's workers' compensation system with the NY Workers' Compensation Board's 2024 conference highlights.

   

Combatting New Jersey Auto Casualty Challenges
When an auto injury occurs, insurers—especially in New Jersey, where strict requirements apply—often struggle to coordinate with multiple vendors, a challenge addressed along with potential solutions by Ben Roberts, vice president of utilization review at Genex.

URAC Certification
Learn about our URAC accreditation.

Frequently Asked Questions

 

  1. What does UR Your Way mean?

    It means you choose the right model for your organization, Full Service, SaaS, Peer Review, or Overflow, and you can scale or adjust without switching vendors.

  2. What is the difference between Full Service, SaaS, Peer Review, and Overflow?

    Full Service runs UR for you and gives you’re the confidence knowing that your UR needs are taken care of and you stay in compliance. SaaS is the technology platform to supports your in-house team and keep you in compliance. Peer Review is an option for when you only need access to a robust peer review network. Overflow adds surge capacity fast as your business needs change.

  1. Can we change how strict UR is over time?

    Yes. Programs can be calibrated by jurisdiction and treatment type, then adjusted as goals and performance data evolve.

  2. Do UR decisions carry through to bills and pharmacy?

    They can. Integrations reduce re-keying and help ensure determinations are enforced downstream.

Let’s Connect

Let’s collaborate to see how we can provide your organization with an effective, efficient and compliant utilization review solution.

Schedule a Consultation