AGS Health's Utilization Management (UM) services assist healthcare organizations in delivering appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews. Their program ensures patient care aligns with current medical standards and optimizes resource allocation. Utilizing MCG and InterQual criteria, AGS Health confirms that cases meet established guidelines and determines the appropriate length of stay. They maintain clear communication with payers and internal teams, identify and mitigate potential risks such as overutilization, and analyze medical necessity denials to address root causes.

Corro Clinical, formerly Versalus Health, offers a utilization management solution that integrates data analytics with a services-oriented clinical expertise to enhance hospital revenue integrity and compliance. Their approach includes refining internal processes, identifying compliance risks, managing denials and appeals, and providing ongoing education.

EvidenceCare's AdmissionCare is an EHR-integrated solution designed to streamline the patient admission process by helping physicians at the point of care in determining the appropriate bed status based on clinical and payer criteria. It reduces medical necessity denials, improves revenue capture through more accurate inpatient decisions, and accelerates handoffs between care teams. The tool also helps physicians focus on patient care by minimizing interruptions related to documentation and bed status issues.