Online Demonstration

Summary Of Actions for Utilization Review

Please answer the following questions about the Summary of Actions taken by the Utilization Review Provider that were checked from the previous page. Once you have finished, please click on the "Next" button at the bottom of this page.

Pre-admission Review
Diagnosis Code
CPT Code
Requested length of stay			Select Day(s) Week(s) Month(s) Year(s)
Authorized length of stay			Select Day(s) Week(s) Month(s) Year(s)
Actual length of stay			Select Day(s) Week(s) Month(s) Year(s)
Date			FROM    mm/dd/yyyy THRU    mm/dd/yyyy
Identified discrepancy code			Select
In-patient Savings			(include dollars and cents) $ .
Additional Comments

Online Demonstration