FAQ

Phare UM continuously reviews 100% of cases to surface payer-specific risk and guide timely clinical intervention, with recommendations tailored to each organization’s clinical policies and risk tolerance.

The buyer depends on where UM sits within the organization. It may roll up to a clinical leader, such as the CMO or CNO, or to a revenue cycle leader. Directors and VPs of Case Management, Care Coordination, and Utilization Review are also key influencers in the buying decision.

"We agree AI shouldn't replace clinical judgment. Phare UM is designed to support clinicians, not make decisions for them — the clinician stays in control of admission status, continued stay, and escalation. The AI's value is surfacing relevant evidence, synthesizing the case, identifying potential risk, and explaining the clinical, documentation, and payer-risk factors behind it. It's also not designed to push toward inpatient status — the goal is better-informed clinical decision-making, not automated decision-making."

Use it to set up a follow-up meeting with R1's clinical experts.

"Clinical criteria are foundational but not always the full risk picture — a case can be clinically appropriate and still vulnerable to payer scrutiny (documentation, timing, observation management, two-midnight considerations, continued-stay rationale, payer-specific patterns). This doesn't mean payer behavior overrides clinical judgment; it means teams have more context earlier, so they decide how to act based on their own policy and risk posture."

InterQual and MCG are clinical criteria used by UM teams and payers to assess the appropriate level of care. Health systems may only have access to one of these, whereas R1 has licenses to both. Seller guidance: Use leverages InterQual and MCG, not InterQual and MCG are embedded.

Phare UM integrates with the client's EHR using standard HL7 and FHIR interfaces.

Partly. UM needs more, so bring in Bill's team early.

Phare UM combines clinical criteria with payer-specific intelligence, denial-risk scoring, AI-driven documentation guidance, and workflow automation, then pairs the technology with R1’s UM expertise to drive better outcomes.

Epic’s approach to UM is primarily designed to assist clinicians with chart summaries and real-time insights. While it can support workflow actions, it does not execute the full UR process, such as making patient-status recommendations or managing the workflow through payer follow-up and peer-to-peer activity. Put simply: Epic helps surface information; Phare UM helps turn clinical and denial intelligence into action across the UM workflow.

One quotes per discharge per month, while R1 quotes per year. The actual costs are similar.

The Two-Midnight Rule is a CMS guideline that helps determine inpatient vs. outpatient status for Medicare and Medicare Advantage patients. If a patient is expected to need medically necessary hospital care spanning at least two midnights, inpatient status is generally appropriate. You can find more info here: PhareUM_Admission_Status_and_Two_Midnight_Rule - Copy.docx