Incedo Utilization Management Solution

Personalized utilization management software driving efficiency, cost savings, and compliance

Improve productivity and reduce costs with exceptional automation

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.

Regulatory alignment promotes compliance and reduces penalty risk

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.

Full integration with care management improves cost and health outcomes

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.

Eliminate utilization management frustrations

  • Effectively manage authorization lifecycle from request and review to determinations and communication with members and providers
  • Eliminate inappropriate and inconsistent care with integrated decision support within the workflow
  • Quickly adapt to changing requirements and new business needs with fully configurable workflows and processes automatically set for the SNP model of care

Improve efficiency and ROI

  • Automated workflows lower costs, improve accuracy, and prevent treatment delays
  • Streamlined authorizations ensure timely, right-sized treatment and more effectively utilize clinical resources
  • Cost-effective care determinations at least restrictive settings ensure timely, right-sized care

Improve member and provider experience

  • Improve turnaround times with real-time decision-making to prevent frustrating delays and ensure care continuity
  • Reduce friction between payer, provider, and member to improve satisfaction and ratings
  • Personalize workflows by provider to enrich experience and create partnership

Optimize quality performance

  • Proactively manage performance via robust quality assurance and customizable reporting to support improvement and accountability
  • Manage turnaround time requirements by authorization type and program
  • Reduce compliance burden via workflow alignment with CMS, NCQA, URAC, and state requirements

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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.

How does the Incedo Utilization Management solution meet my needs?​

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 Solution features

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:

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