UUtilization ManagementCORE

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

See how a digitally connected platform can help your organization positively impact a patient life.

Features and Functionality

  1. Pharmacy / medical authorization
  2. Integration with pharmacy databases
  3. Track cost savings
  4. Network integration
  5. Member 360 view
  6. Track authorization history
  7. Provider portal
Utilization Management, Care Management, Medication Therapy Management modules connected

Combine these modules for even greater benefits.

Let’s get started.

Contact us to see how we can help.