Streamline and speed review workflows
Industry standard-of-care and regulated-use guidelines exist in disparate sources and are cumbersome to navigate. We help you streamline the review process, reduce review times and support consistency by seamlessly converting third-party sources into a structured, interactive tool within your utilization management (UM) workflow.
What’s included in Industry Content
Medicare Content Navigator
Access Medicare National and Local Coverage Determinations (NCD/LCDs) and related policies in a structured, interactive Q&A format.
With an easily accessible link to the Medicare Coverage Database, your team will have in-workflow access to all NCDs, LCDs and associated policies, streamlining your medical review process and increasing consistency.
Weekly notifications of CMS revisions and monthly content updates provide your organization with the most up-to-date LCD/NCD policies.
Streamline the review process for substance use disorder patients
Our navigator tool was developed through an exclusive partnership with the American Society of Addiction Medicine (ASAM). The ASAM Criteria® appears in a structured, interactive Q&A format.
Developed in partnership with ASAM, this interactive version of their criteria helps you increase consistency and significantly reduce the time required for SUD patient assessments while aligning with CMS 1115 waiver requirements and state mandates.
Comprehensive content is fully consistent with The ASAM Criteria, including all 4th edition adult levels of care, withdrawal management services and dimensions of assessment.
Concert Genetics Navigator
Get Concert Genetics coverage criteria in a structured, interactive Q&A format. Our comprehensive content has more than 18,000 molecular and genetic diagnostic tests mapped to specific criteria with the remainder of the 175,000 available tests covered by general criteria.
Our GTU™ test identification system has a unique identifier for each genetic test to quickly identify the correct criteria to apply. We also provide semi-annual content updates.
Available modules
Available modules include:
- The ASAM Criteria®, exclusive access
- Concert Genetics
- Medicare Behavioral Health
- Medicare Post-Acute and Durable Medical Equipment
- Medicare Imaging
- Medicare Molecular Diagnostics and Lab
- Medicare Pharmacy
- Medicare Procedures
Key benefits
Get structured, interactive guidance to drive consistent, efficient reviews.
Streamline with an intuitive Q&A format
Simplify and speed review workflows, reducing review times and increasing consistency.
Integrate seamlessly within your workflow
Provide a single source for content to minimize the need to use and update multiple systems.
Streamline reviews for Medicare patients
Quickly align your decisions with hundreds of Medicare NCDs/LCDs and related policies by relying on structured criteria.
Easily align to SUD mandates
Improve the medical review process for substance use disorder patients with The ASAM Criteria® converted into a structured, interactive tool.
Simplify reviews for genetic testing
Increase consistency with Concert Genetics coverage criteria and comprehensive GTU™ test identification system integrated within our solution.
Schedule a demo
Let us show you how to leverage our comprehensive, evidence-based clinical support solutions.
Related healthcare insights
On-demand webinar
Learn how to streamline efficiency and consistency of the utilization review process.
On-demand webinar
Discover how to meet the latest regulatory requirements for Medicare Advantage plans.
On-demand webinar
Discover how to leverage automation for centralized, exception-based utilization management.
Complementary solutions
InterQual Criteria
InterQual Delivery
InterQual Optimization Solutions
The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine.
GTU is a trademark of Concert Genetics.