Utilization Management

Summary

This enhancement to Utilization Management modifies UM behavior when the STAT or Gold Card Physician values are updated after UM has been auto-approved.

Previously, RIS would automatically approve/finalize UM if the order is marked as STAT or if the referring MD is a Gold Card doctor (refer to Feature #17708 for details), but would later automatically adjust related values affecting the UM Clock if the referring physician or STAT values were modified.

For example, when UM was manually finalized with a non-Gold Card referring physician, and this referring physician was later changed to a Gold Card doctor, the auto-approval workflow would be triggered even though UM had already been finalized. This resulted in inappropriately updating the UM Resolution, Owner and Finalization Date, making it appear that it took longer to complete UM review, possibly putting the action out of compliance with Medical Group agreements.

With this change, when the UM Status is already finalized, the UM Status, UM Resolution, and all UM Authorization time stamps (as well as the UM Clock) will no longer be adjusted when the referring physician or STAT setting is updated.

Configuration Instructions

No System Administrator actions are necessary to enable this feature.