Health care leaders nationwide are working together to improve utilization management processes. The goal is to improve patients’ access to safe, timely, and affordable care, while reducing administrative burdens for health care professionals, hospitals, and health insurance providers.
Today’s UM teams are largely relying on phone/fax to gather clinical information, reviewing each and every case and often outreaching to provider offices multiple times for clarity or additional patient information. Meanwhile, the patient waits, often for days or weeks, for well-intended providers and UM teams to coordinate care. A new solution is needed – SmartUM.
SmartUM is a utilization management system that fosters collaboration among payers, providers, and patients. SmartUM connects the care team online, increases productivity, and generates instant UM decisions. It’s the perfect solution for any health plan or provider organization performing in-house UM.
for electronic referral submission, that leverages integrated payer rules, specialist matching and decision support tools, so that patients are matched with preferred, in-network providers and referrals are clinically appropriate and administratively complete.
that electronically links the care team: the ordering provider, UM, and the specialist on one shared system. This connectivity increases the speed and quality of information flow, allowing for greater care coordination.
UM WorkFlow Queues
starting with SmartUM’s auto- approval of a subset of cases and subsequent prioritization of remaining cases for manual review. SmartUM presents the UM team with clean and complete case information, not a fax, to facilitate fast, quality reviews. Case- routing, attachments and queue management are just some of the other process tools included in SmartUM.
AI and Machine Learning
instantly approves a subset of requests, based on your business rules and past decisions, and continually learns more from every decisions you make.
Approval, Denial and Appeals
Workflow Smart routing delivers the right information to the right UM team member at the right time and the ordering provider, specialist and patient are notified of the referral status in real-time.
With customizable security settings, user-group management, rules and guideline options.
Reporting and Analytics
Easy and flexible reporting relating to productivity, turn-around-times, compliance, plus ad hoc reports you can easily define and run.
Patient and Provider Communication
Tools keep everyone informed – online, by fax, or by letter. Letter templates from multiple health plans are available in 25+ languages
that connects SmartUM with your other systems, including: payer systems, provider EMR, scheduling, printing service, and more.