A member-centric view contributes to Utilization Management outcomes that address the whole person’s care.

Improves outcomes for patients, streamlines entry for providers, and equips clinicians with a 360-degree view of the member.

Benefits

Utilization Management Software: A financially sound and streamlined approach to claims processing.

Based on nationally recognized clinical standards and guidelines, the Utilization Management (UM) Module is comprehensive and easy to use.

01Intake / Eligibility
Integrated eligibility for member and benefits review with personalized authorization workflow.
1/7
02Criteria
Integrate with national evidence-based standards and custom criteria sets.
2/7
03Ease of Documentation
Case notes, call logs, hot links, clinical documents, and correspondence are all available within the authorization screen. Bookmark records to allow easy transitions between cases throughout the workflow.
3/7
04Authorization Determination
Supports multiple administrative and clinical reviews with individual service line support for full and partial approvals and denials and configurable authorization status.
4/7
05Multiple Communication Channels
Fax, email, text, and letters are all supported forms of communication.
5/7
06Reporting and Performance
Interface with client claims system. Dashboards manage and assist with day-to-day supervisory tasks, TAT. Both preconfigured and ad hoc reports are available.
6/7
07Appeals and Grievances
A self-contained appeals and grievances module with the ability to interface with existing appeals and grievance systems streamlines the appeals process.
7/7