Automate tedious, low-ROI tasks and speed care determinations across medical and behavioral health to improve outcomes with timely, appropriate, and cost-effective care. Our utilization management solution offers self-serve configurability and decision support so you efficiently deliver the right care at the right time, location, and level.
Align processes and workflows by program with regulatory guidelines—including CMS, NCQA, URAC, and state requirements—so you can proactively manage performance and ensure compliance.
Collaboration across care and utilization management via a single record ensures at-risk members get the care they need while preventing unnecessary treatment to help you reduce waste, save costs, and improve the health of those you serve.
The Incedo Utilization Management solution seamlessly integrates medical and behavioral health utilization management and promotes medically necessary and cost-effective care determinations for members in the least restrictive settings.
The Incedo Utilization Management solution helps you efficiently manage the complete authorization lifecycle and tracking of prior authorizations across the continuum of healthcare services. Our solution enables organizations to identify high-risk, high-need, and high-cost members and authorize appropriate services. Individuals identified with under/over utilization or high risk can be automatically flagged and referred to the care management team for potential enrollment in the appropriate care management program.
Our utilization management solution:
Incedo Utilization Management software provides a highly configurable and automated approach to managing requests for services, ensuring services are clinically appropriate, and efficiently performing utilization review.
Key features of the Incedo Utilization Management solution include: