Utilization Management Solutions

The Incedo Utilization Management Solution provides a highly configurable and automated approach to managing requests for services, ensuring services are clinically appropriate, and efficiently performing utilization review.

The Utilization Management Solution provides seamless medical and behavioral utilization management to support the complete authorization lifecycle & tracking of prior authorizations across the continuum of healthcare services.

The solution ensures services are authorized appropriately by promoting medically necessary and cost-effective care determinations for members in the least restrictive settings and offers capabilities to properly identify high-risk, high-need and high-cost members. Members identified with under/over utilization and high-risk members can be automatically flagged and referred to the Care Management team for potential enrollment in the Care Management program.

Key features of the Incedo Utilization Management solution include:

• Rule-based automated tasks, reminders & actions
• Authorization & referral management
• Integrated medical and behavioral UM
• Auto authorization according to customized business rules
• Integration with Clinical Guidelines
• Appeal management
• Complaint & grievance tracking
• Auto-generated letters & notifications, individual and batch processing
• Single record for UM and CM
• Activity tracking & management
• Forms and data field customization
• Provider portal for authorization submission and real-time status