Turn Utilization Management into your health system's strongest financial lever.
Long Tail helps health systems turn UM into a strategic capability. We bring new technology, decades of clinical and revenue-cycle expertise, and hands-on change management. Get paid for the care you deliver, without the administrative burden.
Payers are deciding what the care you provide is worth
When a payer decides to downgrade an inpatient case to observation, that one decision can cost your health system $12,000. Payers make that call using criteria, regardless of the care you deliver, and they often get it wrong.
In a study of 30,000 cases, 28% of the cases that failed criteria were paid as inpatient after review. You can win those cases, but each one takes clinical review, physician time, and documentation.
Payers contest so many that your team can't keep up, and patient status is just the start. We call these shenanigans.
The criteria hoax
Changing the goalposts
Automated denials
Increased denial workqueues, rising administrative costs, higher cost to collect
Denials increase, cost of administration skyrockets, processes are impacted.
Stop the payer shenanigans.
Long Tail levels the playing field. When payers deny, downgrade or delay, we help you push back with the physician advisors, workflows and clinical justification it takes to win. With Long Tail, you get paid for more of the care you deliver.
It's time to take back your margin
Better technology alone won't fix utilization management. Modern UM runs on a different operating model: the right task, performed to standard, at the right time, by people working at the top of their license. Here's how the model works.
Automate
Use modern technology to automate the workflow itself, not just isolated tasks, so your staff works at the top of their license.
Staff
Provide continuous expert coverage seven days a week, so UM teams set the correct patient status at admission and update it throughout the stay.
Review & Secure
Review every patient, every time. Secure payer agreement on the assigned status within 24 hours.
Escalate
Escalate every disputed case to the right level of expertise, from physician advisor to peer-to-peer to formal appeal, until it's resolved.
Measure
Track observation rate, denial rate, recovery rate, and cash per bed-day. Hold payers accountable and feed the results back to your Denials teams and UM committees.
Level the playing field with Long Tail solutions
CareAssist
AppealAssist
Physician Advisory
UM Managed Service
Find the margin hiding inside your UM operation.
Start with the numbers you already have: observation rate, denial rate, overturn rate, and UM operating cost. We'll help you see what they're really saying.