Structured, Configurable Utilization Review — Built for Speed and Compliance

Bring intake, reviewer assignment, determinations, letters, reporting, and compliance into one workflow — reducing administrative work while improving visibility and control.

Built for workers’ compensation, managed care, peer review, and other regulated medical review teams.

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    Why UR Teams Outgrow Generic Systems

    • Deadlines are harder to manage when intake, review, and follow-up happen across too many steps.

    • Reviewer assignment is difficult to manage across specialty, licensure, jurisdiction, availability, and workload.

    • Supervisors lack practical visibility into due dates, queues, productivity, and bottlenecks.

    • Legacy, low-structure, or claims-centric systems make it harder to capture determinations, treatment details, and reporting data consistently — leading to workarounds, spreadsheets, and compliance risk.

    Proof: Our clients report saving 1-2 hours per UR nurse/physician per day, and some departments report doubling throughput.*

    *Time savings are self-reported by customers based on typical case volumes and workflows; results vary.

    Structured, Configurable Utilization Review

    • Workflow Automation — fewer manual steps
      Rules-driven queues, routing, assignments, templates, and communications help reduce repetitive handling and keep reviews moving.

    • Visibility & Reporting — better oversight without spreadsheets
      Dashboards, worklists, and report outputs help supervisors track due dates, turnaround times, queue health, and productivity more easily.

    • Reviewer Management — assign the right case to the right reviewer
      Supports reviewer matching based on specialty, licensure, jurisdiction, workload, experience, and schedule.

    • Intake & Review Prep — reduce front-end administrative work
      AI-assisted indexing and summarization help teams process inbound documents faster and prepare the review more efficiently, especially when record volume is high.

    • Compliance Support — stay on top of timelines and documentation
      Jurisdiction-aware due dates, client-specific workflow rules, standardized correspondence, and full action history help teams stay audit-ready and maintain a defensible review record.

    • Configurable Workflows — adapt to how your organization already operates
      DataCare supports internal review workflows, vendor handoffs, jurisdiction-specific rules, and reporting needs without forcing every case into the same rigid process.

    Massachusetts UR Modernization

    See how a Massachusetts UR program replaced aging infrastructure while preserving established workflows and improving audit traceability, reporting visibility, and long-term operational resilience.

    Read the case study →

    Built for Real Utilization Review Teams

    Everything you need, one login.

    Core Features and Benefits

    Structured UR Workflow

    Template-driven UR workflow helps teams capture request details, treatment information, rationale, and determinations more consistently.

    Improve consistency, reduce rework, and make UR data easier to track and report on.

    AI Document Assistant

    Use AI-assisted indexing and summarization to reduce the time spent organizing and preparing inbound medical records for review.

    Lower front-end administrative effort and help reviewers get to the key facts faster.

    Built-In Compliance & Audit Trail

    Manage jurisdiction-aware due dates, standardized correspondence, and complete action history in one system.

    Support audit readiness, appeals, client reporting, and defensible decisions.

    Reviewer Assignment & Balancing

    Automatically route requests to peer reviewers and nurses by

    • Specialty & treatment matching
    • Jurisdiction & licensure
    • Availability
    • Current workload
    • Program/referral rules
    • QA score
    • Cost

    Reduce assignment delays and help teams stay on top of due dates.

    Dashboards, TAT & Productivity Reporting

    Track turnaround times, productivity, volumes, workload, and queue health with dashboards and report outputs designed for supervisors and leadership.

    Give managers practical visibility without relying on manual spreadsheet rollups.

    Integrations

    Direct data feeds with

    • Claims systems
    • Accounting/Finance
    • Bill Review platforms
    • UR & Peer Review partners
    • Provider network systems
    • Enterprise platforms

    Eliminates manual entry, reduces errors, and accelerates workflows.

    Proven to Improve Workflow Fit, Visibility, and Performance

    “DataCare really understands the case management and utilization review ecosystem. Their platform is robust and stable, a must-have in a systems provider. Our focus at Ascential Partners is to promote the right treatment so our patients get back to their lives using the most expedient, cost-effective, and solution-minded way. DataCare is an important partner, helping us with our mission.”
    Michele Settel, President of Ascential Care Partners

    “The entire team we worked with made every effort to understand our requirements and fulfill them as best as possible. They were open to listening to our users and adapt the Ahshay platform to their needs, this is quite unlike most vendors who are rigid and unwilling to even consider that client requirements may benefit their products. The team on our project was very patient with our end users, who are non-technical.”

    Anant Joshi, Information Systems Director at Charter Management

    Join utilization review and managed care teams already accelerating care decisions with DataCare.

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