A proactive approach to utilization management
Case Intelligence is a case stratification solution that leverages artificial intelligence to identify the likelihood of inpatient admission and, based on your organization’s customized workflows, recommends next steps. This enables utilization management (UM) teams to efficiently prioritize first- and second- level reviews, optimize physician advisor time and consistently take action.
Key features
Accurate and trustworthy insight
Case Intelligence utilizes advanced large language models trained on an extensive data set from diverse patient cases — including utilization review information and claims data — to calculate a case stratification score (CSS) which reflects the likelihood of an inpatient admission.
Based on data on file, a high score indicates a strong likelihood of inpatient status, correlating with a 98% accuracy rate of the patient status at time of discharge.
Tailored next-step workflow
When setting up Case Intelligence, organizations can develop tailored workflows using the CSS and admission order as well as variables like payer designation. These suggested actions are displayed in your worklist, facilitating quick and consistent next steps such as submitting for authorization, forwarding for secondary review or ongoing case monitoring.
Key benefits
Case Intelligence can help you optimize utilization management (UM) operations, reduce denial risk and improve revenue integrity.
Efficiency and consistency
The case stratification score allows for efficient prioritization of first- and second-level reviews. It helps to quickly identify status mismatches and potential observation-to-inpatient conversions. Organization-defined next-step workflows enable quick, consistent action and reduce secondary review volume.
Optimized clinical operations
Case Intelligence enables UM staff to shift away from working through a case list. They are able to quickly prioritize initial reviews, efficiently identify cases that warrant secondary review and take consistent next steps. This allows both UM staff and physician advisors to focus their time and expertise on cases where they can be most impactful.
Stronger revenue integrity
Case Intelligence enables a more proactive approach that helps mitigate the risk of denials due to inappropriate patient status and optimizes clinical time and expertise.
Trust and defensibility through AI, automation and clinical evidence
Pairing Case Intelligence with our medical review automation solution, InterQual® AutoReview, empowers UM teams to work proactively while fostering transparency and trust through automated reviews.