The UR summary, drafted against the criteria you already use.
Utilization review software for UR nurses and payers: Medrecords AI reads the request and the records behind it, then drafts the UR summary against the guideline criteria you already work from, citing the record page for each one. The medical necessity determination stays with the reviewer who signs it.
What you walk out with
The summary in the shape your determination letter needs, with the record evidence for each criterion already pulled and cited.
The criteria table
Each criterion in the guideline you work from, set against what the submitted record does and does not document, with the page number on every row.
The treatment course
Conservative care attempted, dates, duration and documented response, pulled out of the file rather than trusted to the request form.
The gaps, named
What the criteria ask for and the file does not contain, flagged before the determination goes out instead of after the appeal arrives.
The summary in your format
Your UR template, your section order, ready for the reviewer to read, revise and sign.
Your judgment, multiplied
The determination is a clinical judgment. A qualified reviewer makes it and puts their name on it. Nothing here moves that.
What moves is the hour spent finding whether the file documents six weeks of physical therapy or four. Reviewers use this to clear more requests a day at the same standard, to answer an appeal with the page already cited, and to spend the time on the borderline cases that actually need a clinician.
How the draft gets built
Three steps, each one a capability you can open and read on its own.
Sort the submitted file
Everything the requester sent, read and deduplicated, so a resubmitted packet does not read as new treatment.
Deduplication →Match the record to the criteria
Documented conservative care, imaging findings and functional deficits lined up against the published guideline language.
Guideline matching →Draft the summary in your format
Your UR template, your criteria set, every line citing the record page it rests on.
Custom report builder →You sign it. That is the point.
The software reads the record and lines it up against the criteria. It does not approve, deny, score or certify anything, and it never decides medical necessity. A qualified reviewer reads the draft, revises it and signs the determination. That is what makes the file defensible on appeal.
UR summary: common questions
Send one request packet. Read the summary it drafts.
Bring a real submission with the records behind it. You get the criteria table and the cited summary back, and you judge whether it saves the reviewer an hour.
Test a file