This highly flexible, parameter-driven module is designed to automate the process of distributing and routing claims, authorizations and other requests to staff.
It allows the streamlining operations and concentration of resources on areas of specialization or concern. This module provides a dynamic environment for enhancing claims and authorizations throughout the claims management process. The module can also be used as an effective tool for monitoring productivity and performance.Evidence-Based Care Engine
The purpose of this module is to increase the automation of claim processing based on evidence-based care protocols. Set protocols can be used as a reference point for validation procedures when benefits are adjudicated or authorized.Multiple guidelines can be defined in the system’s parameters to support:
Tailoring managed care procedures to the requirements of individual clients Creating managed care regimes with different levels of flexibility for the purpose of utilization control