February 2026: Smart UR Strategies for 2026
Stay Compliant Without Compromising Care or Revenue
February 2026: Smart UR Strategies to Stay Compliant Without Compromising Care or Revenue
Utilization Review (UR) is evolving fast. In 2026, providers are navigating a landscape shaped by regulatory shifts, payer policy changes, and growing pressure to reduce administrative burden—all while protecting access to care and financial sustainability.
Thanks to insights from Lauren Jensen, Director of Utilization Review at Hansei, we explored how smarter UR workflows can help organizations stay compliant, reduce denials, and safeguard both care delivery and cash flow.
Lauren Jensen
Director of Utilization Review
Hansei Solutions
If you missed it, you can view the recording here:
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Data-Driven UR in a Changing Landscape
Hansei’s scale offers a rare view into the realities of modern UR. With analysis spanning 2 million verifications of benefits (VOBs) and millions of claims, we’ve found clear patterns emerging.
That said, UR processes must align tightly with national clinical standards and payer compliance requirements. When workflows drift from these benchmarks, denial rates rise, and teams are left reacting instead of planning.
At the same time, the administrative load on clinicians and UR teams continues to grow. We highlighted how agentic AI can play a role in streamlining repetitive tasks, allowing teams to focus on higher-value clinical and coordination work rather than paperwork.
The Operational Realities & Challenges of UR
UR challenges are rarely theoretical—they show up in day-to-day operations.
Lauren noted that many teams struggle with multiple care managers assigned to the same client, which can fragment communication and create inconsistencies in documentation. Without a centralized approach, this complexity increases denial risk and slows down authorizations.
Strong clinical documentation remains the backbone of effective UR. Clear, consistent notes that articulate medical necessity are essential—not only for approvals, but also for successful appeals when denials occur. Clinicians who understand how UR works, and why certain details matter, are far better positioned to protect both patient care and reimbursement.
Why UR Coordinators Belong on the Treatment Team
One of the strongest themes from the discussion was the value of embedding UR coordinators directly into treatment teams.
When UR professionals are seen as partners rather than gatekeepers, communication improves. Trust builds. Clinicians feel supported instead of scrutinized. This collaboration leads to cleaner documentation, faster authorizations, and fewer preventable denials.
UR coordinators also serve as guides—helping clinicians navigate shifting payer rules, interpret requirements, and adjust documentation in real time. Their role is not just administrative; it’s strategic.
Flexibility Is No Longer Optional
Payer requirements continue to vary widely, and rigid UR workflows simply don’t hold up. Teams must remain flexible, adapting processes based on payer mix and levels of care.
UR allocation per person reflects this reality. In some settings, coordinators may manage around 15 reviews per day; in others, especially with more complex payers or higher acuity levels, 6 per day is more realistic. Capacity planning has to account for complexity—not just volume.
2026 UR Shifts: Reducing Barriers to Care
Looking ahead, 2026 is bringing meaningful shifts in utilization review, particularly in behavioral health.
Some states and payers are limiting or waiving UR requirements for the initial hours or days of care
Criteria are increasingly evidence-based and parity-aligned
Opaque, payer-specific rules are being phased out in favor of standardized approaches
Documentation Matters More Than Ever
As UR becomes more standardized, documentation is under greater scrutiny.
Reviews rely heavily on nationally recognized clinical standards
Medical necessity must be clear, consistent, and well supported
Strong documentation not only prevents denials—it strengthens appeals when they occur
In short: good documentation is no longer just good practice; it’s a financial safeguard.
Smart Workflows Protect Care and Cash Flow
The most resilient organizations are investing in smart UR workflows that balance compliance with efficiency:
Automating authorizations to reduce administrative burden
Aligning UR processes to clinical standards to improve approval rates
Tracking denials in real time to prevent treatment disruptions and reimbursement delays
When UR is proactive rather than reactive, everyone benefits—patients, clinicians, and the organization’s bottom line. That’s all for this month, we’ll see you in March!