Working together on utilization review requests
Timely clinical input from your office gives every review its best chance of approval— protecting your patient’s access to medication and your claim payment.
When a payer opens a Utilization Review (UR), the clock starts. Advanced Rx collectors track each request, clarify what’s needed, follow up, and escalate—but the clinical evidence that supports medical necessity lives in your office. The sooner we connect, the more complete our response can be before the payer’s deadline.
01 How your practice can help with utilization review requests
STEP A
When a UR arrives
Review it right away. Early review buys time before the payer’s deadline.
Loop in your CSS. If a UR lands at your office, forward it to your Advanced Rx Client
Services Specialist (CSS) so we can track it from day one.
STEP B
Build the clinical case
Send current clinical documentation (see checklist below).
Make the case for medical necessity. Show why this medication is right for this patient and related to the compensable condition.
Answer clinical questions. Clarifications or updated orders carry the most weight coming from the treating physician or clinical team.
Say yes to peer-to-peer. A timely call with the UR reviewer adds clinical context and can improve the opportunity for approval.
WHAT TO SEND: office notes · diagnosis · treatment & medication history · prior treatment outcomes · objective findings · treatment plan · Letter of Medical Necessity (when requested)
S T E P C
Keep it moving
Meet the review timeline. Send requested items within the timeframe we share.
Keep contacts current. Clinical contacts, fax numbers, secure email, and a backup
contact.
Tell us when it’s done. A quick confirmation prevents duplicate outreach.
02 How Advanced Rx collectors support you
01 Review
Account, payer notes, status, deadlines, records on file.
02 Connect
Clear request to your CSS: what’s needed and by when.
03 Document
Every call, email, and record logged for visibility.
04 Follow Up
Reconnects on a set cadence until items are in.
05 Route
Submits records through the right channel.
06 Monitor
Tracks UR and claim status to a decision.
07 Escalate
Alerts your CSS if a deadline nears or a denial lands.
03 The UR follow-up & escalation path
STAGE | ADVANCED RX WILL | YOUR PRACTICE CAN | EXTRA SUPPORT WHEN |
|---|---|---|---|
| Review the request, flag missing items, notify your office, and log the due date. | Confirm receipt, forward any UR sent to you directly, and start gathering records. | Urgent deadline, unclear request, or patient- access concern |
| Contact your designated rep and restate missing items and the deadline. | Send the records—or an estimated completion date. | No response or incomplete documentation |
| Make a second documented outreach and advise the item may be escalated. | Close remaining gaps; decide whether physician input would strengthen the review. | Repeated non-response or an approaching deadline |
| Escalate to our lead, manager, and Client Services for coordinated outreach. | Practice leadership helps find the right contact and remove barriers. | Deadline at risk, non- certification, denial, recurring issue, or financial impact |
| Share the open issue, outreach history, risk, and next action with your designated practice leader. | Partner with the physician or clinical team to resolve it and confirm next steps. | Continued inaction, repeated UR failures, or unresolved patient- access concern |
OUR SHARED GOAL
The strongest possible response on every UR
Clinical Voice.
The treating physician’s perspective explains the medical need best.
Fewer Delays.
Complete, timely records can reduce delays and non-certifications.
Protected Access.
Early coordination keeps patients on therapy, with less back- and-forth.
Better Outcomes
Together we improve the opportunity for authorization and payment.
