Optimize your UM workflow for better efficiency and revenue.
The traditional utilization review (UR) processes can be inefficient and error prone. With clinical staff shortages and an expanding scope of responsibilities, the administrative burdens and inconsistent processes contribute significantly to these inefficiencies.
Plus, clinical staff are often unable to work at the top of their licenses due to the time and effort diverted towards administrative tasks.
Case Advisor combines technology powered by artificial intelligence (AI) and evidence-based content within a workflow efficiency platform to provide hospitals a comprehensive utilization management (UM) solution. and devote more time to other patient-focused responsibilities.
For physician advisors, the platform highlights key medical facts from patient records and links them to relevant citations from a comprehensive database of medical research. This supports improved compliance and defensibility of patient status decisions and helps strengthen your revenue integrity and defend against payer denial.
Utilization management software that improves efficiency
AI case stratification
Leverage large language models (LLMs) trained on diverse patient cases, incorporating a unique combination of clinical data, utilization review and claims information.
AI-enabled case stratification sorts and scores acute medical cases based on the likelihood of inpatient admission, enabling clinical staff to prioritize their case lists and concentrate their efforts on cases that require further review.
This prioritization also helps them determine which cases should undergo a first- or second-level review first, streamlining the review process and enhancing overall efficiency.
Physician advisor case review
Using AI, Case Advisor's physician advisor view efficiently extracts key medical facts from patient records and links them to relevant citations from a comprehensive database of medical research. This not only saves valuable time, it enhances peer-to-peer discussions, providing physicians with factual support to facilitate their conversations with payer medical directors.
Key benefits
Our unique AI-powered workflow solution enables a strategic approach to utilization management.
Optimize clinical operations
AI sorts cases and scans records, serving key facts instantly, saving time and focusing attention on critical reviews.
Enhance revenue integrity
NLP extracts key facts from the patient record and links to relevant research citations, for defensible decision making.
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