Medical necessity review that keeps pace with admissions.
Concurrent utilization review aligned to InterQual and MCG criteria, integrated into your existing case management workflow.
0%
Level-of-care determination accuracy
0%
Reduction in avoidable denial days
Daily
Concurrent review cadence
How Sevynox approaches utilization management
Utilization management is where clinical judgment meets payer criteria — and getting it wrong in either direction creates problems, from avoidable denials to unnecessary length of stay. Sevynox UM specialists apply InterQual and MCG criteria consistently, working alongside your case management team.
Concurrent review keeps status determinations current throughout the stay, so level-of-care disputes get resolved while the patient is still admitted, not months later in an appeal.
Works well for
What changes once this is running.
Consistent criteria application
InterQual and MCG standards applied uniformly across every review.
Fewer avoidable denial days
Concurrent review catches status issues before discharge, not after.
Case management support
UM specialists work as an extension of your existing team.
Payer communication support
Status disputes are addressed proactively during the stay.
How an engagement actually runs.
Admission review
Initial status and level of care are reviewed against clinical criteria at admission.
Concurrent monitoring
Ongoing daily review tracks continued stay necessity and status accuracy.
Payer communication
Status and continued-stay determinations are communicated proactively to payers.
Discharge planning coordination
UM findings feed directly into discharge planning to avoid delays.
What's included.
InterQual & MCG application
Consistent, criteria-based review across the full inpatient population.
Concurrent denial prevention
Issues are identified and addressed while the patient is still admitted.
Case management integration
UM specialists work inside your existing case management workflow and tools.
Observation status monitoring
Active tracking to prevent inappropriate extended observation stays.
The AI layer behind this service.
Criteria automation support
InterQual/MCG criteria checks are supported by structured digital workflows.
Concurrent risk flagging
Cases at risk of status or length-of-stay issues are surfaced daily, automatically.
UM-to-billing integration
Final status determinations flow directly into billing to prevent mismatches.
Community health system, 2 hospitals
Challenge — A two-hospital system's case management team was stretched too thin to complete concurrent review consistently, resulting in a high rate of retrospective status denials.
Approach — Sevynox UM specialists joined as an extension of the existing case management team, providing daily concurrent review capacity.
0%
Reduction in avoidable denial days
0%
Level-of-care determination accuracy
0%
Admissions reviewed within 24 hours
Questions we hear most.
See what utilization management looks like on your own claims.
A working session with our team, scoped to your specialty mix and payer contracts — not a generic slide deck.