Ensure your members are receiving the services they need when they need them.
Fully integrated solution for Medical, Behavioral, Pharmacy and Dental Utilization Management
The Incedo Utilization Management solution promotes medically necessary and cost-effective care determinations for members in least restrictive settings, and provides the tools needed to manage the complete authorization lifecycle and tracking of prior authorizations across the continuum of healthcare services.
Incedo provides seamless utilization management capabilities to properly identify high-risk, high-need and high-cost members, and ensures services are not authorized inappropriately.
Features of Incedo Utilization Management
Authorization and Service Requests – Review requests for service and determine the most appropriate provider, service type and treatment setting. Provides a dashboard view of all services for a member, including details of authorizations and referrals for community based services.
Automated Authorizations – Automatic authorization processing based on standard rules as well as customized business rules by provider and level of care.
Tasks and Reminders – Automated tasks and reminders for concurrent and retrospective reviews, Medical Director reviews, and follow up after hospitalization and helps to meet URAC standards for authorization decision and notification timeliness.
Appeals – Track multiple levels of appeals utilizing workflows to support compliance with CMS, NCQA and URAC compliant timeliness, elements and processes.
Integration – Fully integrated with member’s Care Management record and industry standard clinical guidelines to support a more efficient clinical review process.
Provider Portal – Enable your requesting providers to submit requests for authorizations electronically with real-time status lookup.
Additional Incedo Utilization Management Features and Benefits:
- Clinical Assessments – Capture all member clinical and needs related information using 45+ preconfigured evidence-based screenings and assessments
- Automated Decision Support – Ensure the delivery of effective evidence-based care with rules-based automated processing
- Complaints & Grievance Tracking – Support quality of care and customer satisfaction by tracking the complaints and grievance process based on CMS, NCQA and URAC supported workflows
- Quality Reporting – View, analyze, visualize, and report data to support continuous quality improvement
- Provider and Community-based Resources Search – Ensure the most clinically relevant and cost-effective provider/resource for services needed by your members with an intelligent provider search
- Auto-generated Letters & Notifications – Enhance communication with automatic generation of fully customizable member and provider letters and notifications
- Configurable Automated Workflows, Tasks & Actions – Improve operational efficiency, adhere to business rules and ensure compliance with timelines anddue dates by configuring custom automated workflows
- Forms & Data Field Customization – Create fully customizable data fields and forms for required data collection, such as health risk assessments, member satisfaction surveys, consent forms, etc.
- Contact Management – Maintain a complete contact record by documenting and tracking every communication regarding a member with all linked forms and activities
- Activity Tracking & Management – View all activities (contacts, services, tasks, letters, etc.) that have occurred for a member in dashboard view for full transparency
- Outcomes Measures – Facilitate actionable and meaningful assessment measures of health outcomes by tracking data and performance to Star, NCQA-HEDIS and other regulatory measures