Best Utilization Management Software
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Compare the Top Utilization Management Software as of October 2024
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What is Utilization Management Software?
Utilization management software is an important tool for helping healthcare providers manage patient care. It can help streamline processes, automate procedures and review treatments to ensure quality and cost-effectiveness. This software also offers features such as pre-authorization requests, clinical criteria checks and concurrent reviews. Finally, utilization management software can help analyze cost savings and outcomes while providing insights into treatment options. Compare and read user reviews of the best Utilization Management software currently available using the table below. This list is updated regularly.
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Ciox HealthSource
Ciox
Every record represents a real person. Each data point is a potential game-changer in someone’s life: a connection to be understood and acted upon. And so our goal is to enable greater health by improving the way health information is managed. For 40 years, Ciox has advanced the healthcare industry through better health information management and exchange of health information. Our broad reach in medical records extends across industries, allowing us to modernize workflows, facilitate access to clinical data, and improve the accuracy and flow of health information. We help our clients manage, protect, and leverage health information to achieve operational improvements, optimized revenue, and better patient outcomes. Ciox HealthSource is a fully scalable clinical data platform Ciox HealthSource is a fully scalable clinical data platform utilizing Artificial Intelligence technology to enable higher quality data, drive down administrative burden and improve financial performance. -
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BlueNote Communicator
BlueNote Software
Set your office in motion instantly. Whether you need to notify someone that a patient has arrived, a task should be managed, or a room is ready for a provider, one click of a Light is all it takes. Because BlueNotes need to be experienced first, by the people who will actually be using them. The program isn’t simply technology that you can view on a monitor to understand how it really works. Strictly speaking, blue notes are the microtones between the regular notes on a musical scale. You can hear them when they’re played or when someone sings them, but there’s no way to write them down. Blue notes are soul - they are what make all the difference between classical and modern music. There is so much more to our BlueNotes than messaging. The system becomes the living heartbeat of an office, so that everyone knows where kindness is needed, every moment of the day.Starting Price: $835 one-time -
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Rallyest
Rallyest
Imagine having a way to support someone in treatment with a mobile secure and user-friendly tool. Wouldn’t it be amazing to have the ability to rally a client’s professional team and their natural network of support to increase the likelihood of lasting treatment success? You can give clients your best with Rallyest. Rallyest is pleased to announce the addition of video capabilities to the must-have line-up of features. By using a smartphone or computer, Rallyest captures secure video to share with a client, their support network, as well as their professionals. Making improved and confidential input, support, and connection possible for those in treatment settings. Engage clients, involve their support network, and boost treatment success for everyone. Rally a client’s extended network of select family, friends, co-workers, clergy, and professionals. Enjoy one location for a client’s photos, videos, updates, files, posts, comments, notifications, announcements, etc.Starting Price: Free -
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AssureCare MedCompass
AssureCare
AssureCare is a privately held healthcare technology company that provides innovative care management solutions to commercial and health and human service providers. AssureCare’s flagship software platform, MedCompass, is used by healthcare providers throughout the United States to deliver end-to-end care management for millions of patients daily. MedCompass transforms healthcare management by automating processes and streamlining workflows, thus allowing care professionals to make better decisions that dramatically improve the quality of care and lower costs. AssureCare is considered an industry leader in developing, modular, seamless solutions designed to improve patient outcomes and reduce avoidable costs associated with population health management. -
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Connexall
Connexall
Connexall, ranked number one and named Category Leader in the 2015/2016/2017 and 2018 Best in KLAS awards, is an enterprise-grade event management and control platform that delivers hospital-wide interoperability to people, systems, tasks, and devices. Its capabilities act as a backbone for clinical workflow, communicating the right information to the right person, at the right time, on the right device. Based on more than 20 years of R&D efforts, the Class II medical device software is completely vendor-neutral and device-independent. Connexall has offices in Canada, the United States, Brazil, Portugal and Hong Kong and works with well over a thousand of the world’s most renowned and progressive hospitals and health systems. Connexall captures organic data from all connected systems and each interaction during an event’s lifecycle to provide high-level, real-time outcome visibility. -
6
Therap
Therap Services
Therap is the industry leader in providing electronic records and documentation in long-term care services for people with Intellectual or Developmental Disabilities. Therap is a web-based application suite that was designed to provide a comprehensive solution for the planning, documentation, reporting, communication and billing needs of organizations supporting people with intellectual and developmental disabilities in home and community-based services (HCBS) and other settings. Using secure cloud technology, the Therap system improves the quality of service within day programs, assisted living facilities, ICF/IID facilities, community support programs and state organizations. Daily communication and reporting between the states, administrators, health care professionals, case managers, quality assurance teams and families becomes seamless. -
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TreeAge Pro
TreeAge Software
TreeAge Pro is the leading tool for building decision trees, Markov models and event-based simulations. TreeAge Software, LLC has been a beacon in decision analysis and health economics for over 30 years. Our team of scientists, engineers, trainers and support associates have grown and developed alongside the decision analytics community to build and refine our flagship software – TreeAge Pro. TreeAge Software, LLC is a privately held company headquartered in Williamstown, Massachusetts. TreeAge Pro is the leading visual tool for creating and analyzing decision trees. Create decision trees of unlimited complexity for any type of decision. TreeAge Pro software is used in a wide array of industries, including healthcare, legal, oil & gas exploration, management consulting, investing, teaching, etc. TreeAge Software has earned the trust of more than fifteen thousand modelers globally, including in the US, Europe, Latin America, Asia, Australia and Africa.Starting Price: $450 one-time payment -
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Clarify Health
Clarify
Distilling fractured health data into actionable insights. Clarify Health’s analytics platform cuts through the fog. We help you thrive in a post-pandemic world by delivering precise insights into provider performance, patient journeys, and therapy adoption. Leverage our advanced analytics software to confidently improve physician performance, match patients to the right care, and navigate value-based arrangements. Access insights to accelerate product launch and growth, demonstrate real-world impact, and enable outcomes-based commercial agreements. Identify top physicians and facilities more accurately, deliver a more personalized experience to members, and maximize value-based engagements. Timely insights through thousands of predictive models that organize data into real-time analyses to drive demonstrable ROI. Driven by big data. Powered by innovative technology. Turning health data into impact. -
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SSI Access Director
SSI Group
Making the front end your first priority. Integrated front-end solutions to improve patient financial experience and revenue cycle results. Determine address deliverability, minimizing returned mail and unpaid invoices. Reduce input errors by confirming patient identity and demographic information. Verify patient insurance eligibility at the point of service. Maximize revenue and regulatory compliance by verifying medical necessity before service. Automate PA end to end in just seconds. Automate the notification process to ensure timely notice of inpatient hospital admittance to payers. Promptly and accurately communicate patient out-of-pocket expenses. Increase collections by determining propensity to pay and financial aid eligibility. Once overlooked, patient access has become a driving force in hospitals. Our flexible platform provides a powerful synergy of integrated information from multiple verification sources combined with intelligent guidance. -
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Collective Medical
Collective Medical
Collective curates patient data into a focused alert to help ED providers make rapid, informed decisions for better patient outcomes. Get notifications for patients with patterns of high utilization or complex needs as soon as they register—notifications are also sent to other members of the patient’s care team, so they can intervene and redirect patients to more appropriate settings for care to avoid misuse of emergency room services. Collective delivers notifications directly into your systems, regardless of EHR, or sends alerts by fax, network printer, email, or text message. This ability to embrace each facility’s unique needs and workflows aligns providers, giving them a shared playbook—wherever the patient goes, the collective follows. -
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MemberMatch
Experian Health
Claims cycles can take months, and by then it is far too late to manage these costs. Even a delay of minutes in awareness of patient activity could result in an unnecessary, costly admission — thus when it comes to care coordination and success in value-based contracts. MemberMatch provides these insights in real time, providing care teams intelligence as early as possible so that they can rally around active episodes of care proactively and efficiently. This helps risk-bearing organizations optimize the quality and cost of member activity in the continuum of care, leading to better outcomes for patients and a better bottom line for organizations responsible for their health. Connect your care team with the attending clinical staff, providing key context to optimize the quality and cost of encounters, potentially avoiding unnecessary, out-of-network admissions and duplicate tests. -
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MyOutcomes FIT
MyOutcomes
FIT eLearning is a new, accelerated, way to learn and implement feedback-informed treatment. Based on the ground-breaking PCOMS evidence-based practice, FIT eLearning is designed to help you gain capabilities and confidence regardless of your learning style. Excellent understanding of PCOMS and FIT. A meaningful outcome and session rating process for clients. Adoption of a simple red, yellow, and green signaling system to keep sessions on track. An ability to map your clinical effectiveness across clients. Identification of your professional baseline. The ability to measure micro improvements in future skills growth. A certificate for 12 hours of online psychotherapy training in feedback-informed treatment. Whether you’re an individual practitioner or part of a larger organization, FIT eLearning helps you develop a culture of feedback and incorporates the outcome and session rating scales (ORS & SRS) into your clinical practice. -
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StrataJazz
Strata Decision Technology
The overall budgeting process for hospitals is badly broken. The typical organization spends three to six months and 100,000+ hours producing a budget that is usually tens of millions of dollars off the mark and out-of-date the moment it is finalized. There has to be a better way… and there is. StrataJazz is the deepest Advanced Planning tool on the market, radically simplifying and streamlining how healthcare providers plan, budget, forecast and manage their operating and capital expenses. The end result is a planning process that is more efficient, accurate, and agile. StrataJazz leverages top-down rolling planning approaches, seamless integration of relevant cost data, and best-practice automation, workflow, and analysis to deliver a collaborative, results-oriented budgeting process and plan that is significantly more accurate and radically less time-intensive. -
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Enable high-value decisions and elevate cross-functional collaboration across the care ecosystem. Incedo™ Healthcare Management Platform offers a comprehensive medical management solution that seamlessly integrates care management, utilization management, care coordination, and health care navigation interventions to improve operational efficiencies and health outcomes. Facilitate communication and collaboration between Care Management, Clinical and Utilization Management teams with a shared view of the member care plan and an easy transition between UM and CM Enhanced Data Capabilities Simplify data capture and CMS compliance using a flexible data repository that is customizable for granular data tracking and reporting simplify data capture and CMS compliance using a flexible data repository that is customizable for granular data tracking and reporting System Interoperability.
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Assurance Reimbursement Management
Change Healthcare
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims. -
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AccuCare
Orion Healthcare Technology
Since 1992, Orion has been providing technology solutions and professional services to improve the workflow for the addictions and mental health profession. The cloud-based AccuCare EHR, Orion’s flagship software product, was designed by a highly experienced team of clinicians and engineers to improve the major areas of your agency, including clinical, financial, billing, administrative, research and analysis. AccuCare includes everything from custom-built screening/assessments, admission/discharge, treatment planning, progress notes, telehealth, e-prescribing, scheduling, electronic billing, custom reporting and more. The AccuCare Web-Based Practice Management System is supported by a dedicated team of specialists, trained to answer every question about your system and how it can be used within your current documentation and billing processes. Customer support is included in your subscription, as well as automatic updates and upgrades based on real customer feedback. -
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iTraycer
Medical Tracking Solutions
Managing inventory is incredibly important to companies in many industries, but maybe more so in the medical device industry where a single product can cost thousands and surgical loaner kits cost tens of thousands. Effectively tracking, managing, and leveraging field inventory enables medical device manufacturers and hospitals to realize increased sales revenue, reduce capital investments in inventory, and lower operating expenses. Medical Tracking Solutions, Inc. (MTS) was established by an experienced team of industry professionals with expertise in the areas of medical device sales, distribution, logistics, loaner kit processing, and software development. Today, manufacturers and hospitals independently use the MTS proprietary software, iTraycer, or they take advantage of our complete service where MTS partners with logistics providers to offer a turnkey solution for case scheduling and medical device field inventory management.Starting Price: $50 per user per month -
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AveCare
Avedon Health Systems
Effectively managing patient care demands the right combination of clinical and software resources. In an industry that is typically labor-intensive, those resources should not only support and enhance the care management process, but also contribute to corporate profitability. AveCare’s seamless integration of care management functions (CM, DM & UM), streamlined workload, management capability and affordable pricing Structure allows organizations to optimize clinical and financial resources while improving quality of care and patient outcomes. Exchange data from multiple sources including: eligibility, claims, networks, pharmacy, diagnostic and lab results, predictive modeling, decision support tools and e-fax. Integrated by design allowing for the seamless integration of case management, disease management/education and utilization management functions. From a single point, view or access all CM/DM/UM activity and information relevant to a particular patient. -
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VitalHub
VitalHub
VitalHub’s portfolio of Patient Flow, Operational Visibility & Patient Journey Optimization solutions are designed for complex hospital and integrated health environments. Our technologies empower frontline teams, clinicians, and leadership to improve patient experiences and achieve higher levels of operational efficiency, resulting in safer care for patients. We deliver solutions which optimize patient flow, perioperative care, demand & capacity, virtual consultations, clinic management, and the patient journey. VitalHub solutions improve transparency and communication through real-time whole system visibility, Integrated information for coordinated care, and optimization of patient movement. VitalHub’s EHR suite of solutions go beyond standard clinical data collection, our solutions provide a comprehensive, holistic view of patients and clients at the point of care. -
20
Getinge
Getinge
The need for integrated solutions and access to knowledge is essential, as technology evolves and therapies become more sophisticated. As your full-service partner, we support you through the entire clinical pathway, so that you can continue to provide excellent care, without ever compromising on quality and safety. Whether you are producing the cures of today or discovering the cures of the future, preventing contamination from occurring is the common challenge. We are there to support you in ensuring a productive and contamination-free research or production environment. Advanced medical equipment needs the combination of smart financial solutions and preventive service maintenance to ensure maximum uptime. We offer you full cost control and peace of mind, allowing you to focus on what's important, saving lives. As a leading medtech company, we focus every talent and resource towards helping our customers save as many lives as possible. -
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The hospital management system can provide an automated way of managing any hospital activities rather than a traditional system. Moreover, this system can operate regular hospital activities like IPD, OPD, billing, test, bed management, account sector, HR management, etc. accurately and efficiently. Also, it helps to generate the daily, weekly, monthly, half-yearly, and yearly reports of sales, revenue, patients, lab test, bed management, etc. as your requirement easily. To see these reports, you need to click on some options. The most important thing is that an admin can observe everyone through the software. An internal messaging platform helps employees to communicate with each other as well. All in all, clinic management software helps you to be with trends, and it also gives you the chance to run your business administration digitally and very efficiently.
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22
Care Management Suite
Health Catalyst
The Care Management Suite is a data-driven care management solution with tools and processes that deliver visibility across the continuum for high-risk and at-risk populations, facilitate more streamlined and patient-centric workflows, improve the quality of patient care, and reduce overall costs. With data analytics revealing opportunities for improvement throughout the process, the Care Management Suite improves clinical, operational, and financial outcomes. The Care Management Suite consists of three applications: Population Builder™: Stratification Module, Population Care Workflow, and Population Care Insights. An end-to-end, streamlined workflow for everything from patient enrollment, active care management, patient records, and care coordination between all care team members saves time and improves care. An analytics-driven DOS platform aggregates disparate claims and EMR data to provide a comprehensive patient view. -
23
CircleLink Health
CircleLink Health
Our setup process is simple. We do the work to integrate our HIPAA compliant software and services into your existing workflow. The software helps stratify your patient population to identify patients who may qualify for CCM and other preventative programs. Our care team + software can manage enrollment/eligibility, patient call cycles, administrative record keeping and more. With our seamless integration, we have our fingers on the pulse of your patients’ needs. Our one-click interface gets physicians crucial information about patients who need immediate attention. Here’s how it works: -
24
Trella Health Marketscape
Trella Health
There are patients who desperately need your home health services — yet many physicians who could be referring them aren’t. That’s likely because your sales and marketing teams aren’t seeing the 75% of Medicare claims associated with office visits. Demonstrate your ability to lower costs and improve patient outcomes. Home Health Agency A can quickly demonstrate how it outperforms Home Health Agency B on hospitalization and readmission rates. Marketscape for Home Health helps you redefine your sales and marketing strategy to ensure you’re focusing on high-potential physician and facility referral sources. Our breakthrough technology and support help you: Quickly evaluate how you compare to your peers by hospital and readmission rates, diagnostic category, acuity level, time to start of care, total cost of care, and many other quality metrics. -
25
Midas Health Analytics
symplr
Coordinating care, evaluating and demonstrating quality, identifying risks, and monitoring compliance all require data from multiple sources and systems — and all are key to improving the patient and provider experience. Midas Health Analytics improves operational and clinical performance with solutions that manage risk, control cost, and turn data into actionable insights. Track and trend performance over time, proactively manage and mitigate risk, make data-driven decisions amid constant regulatory changes, and elevate and foster a safe care environment for all. Reach unprecedented operational efficiency when evaluating, interpreting, and demonstrating quality of care performance results to stakeholders in today's complex healthcare ecosystem. -
26
Provation
Provation Medical
Many hospitals, ambulatory surgery centers (ASCs) and health systems experience significant procedure documentation challenges. Most physician documentation methods, including dictation, transcription and EMRs, lack standardization which can lead to inaccurate, incomplete and non-compliant procedure notes. The resulting reports are not searchable or easy to analyze because they are built with unstructured data. Not to mention, insufficient, tedious workflows lead to financial losses and frustrated physicians. Guides physicians through an intuitive workflow navigation tree to offer appropriate selections for quick documentation. Helps organizations meet quality and compliance standards by allowing users to run over 100 reports and analyze structured data reports. Connects directly with endoscopy scopes to collect all relevant images and add them to procedure notes. -
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Carta Healthcare
Carta Healthcare
Our industry-leading, artificial intelligence (AI)–driven technology converts both structured and unstructured healthcare data into a high-quality, reliable, standardized dataset that can be used across your organization. Accessing data in near real-time from disparate systems, our products and services reduce the burden of manual data abstraction so your administrative and clinical teams can recapture that time for quality and research initiatives. Our products and services allow you to collect, analyze, and act on your data, regardless of data source, therapeutic area, organizational department, or existing reporting, BI, or analytics tools. Atlas uses human expertise and the power of AI to automate and simplify the resource-consuming task of finding and interpreting patient data for clinical registries. Cartographer searches, analyzes, and interprets patient data across all platforms, standardizes those data into a consistent format, and provides relevant data recommendations. -
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OASIS Intelligence
Inovalon
Improve organizational performance and validate OASIS data more efficiently with cloud-based quality reporting and analytics software for home health. Empowering home health agencies to identify actionable opportunities to improve outcomes and star ratings, reduce readmissions, boost referrals, and increase revenue. OASIS Intelligence is the go-to resource for your home health agency’s performance improvement needs. From organizational performance analysis to accurate and rapid validation of OASIS data, our cloud-based application has you covered. Access the most current data available to identify performance trends and gaps, drive faster process improvements, and increase star ratings. Ensure quality and proper reimbursement with automated alerts that help you stay on top of errors and inaccuracies on the OASIS form. View everything from monthly trends and condition-specific analyses to patient-level results with our comprehensive and flexible reporting. -
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XSOLIS CORTEX
XSOLIS
A new category of utilization management software, CORTEX provides a 360° approach to addressing the intricacies of utilization management and revenue cycle processes. Powered by real-time predictive analytics and machine learning engine, CORTEX ensures that the right cases are handled at the right time, by the right staff or by exception. CORTEX incorporates precision medicine upon a foundation of evidence-based medicine. Machine learning models operate in real-time to better assess your patient population. Our analytics have been deployed in hospitals and health plans across the nation. With clear inpatient cases, CORTEX does the heavy lifting by automating inpatient determinations on cases that meet your unique threshold. For difficult cases, CORTEX offers your staff the insight they need to make a strong determination. This approach offers incredible value to payers and providers alike. -
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Medius Health
Medius Health
Unleashing the power of Medius’ multi-cloud artificial intelligence platform to deliver greater than 90% accuracy and coverage on various health intelligence and risk predictions using just a few health variables. Using just a few health data co-ordinates, Medius’ multi-cloud artificial intelligence platform aggregates, and mines massive datasets to create all relevant health risk and underwriting insights within seconds, with over 90% accuracy and coverage that can help providers and payers with their health and life needs assessments, distribution, operations efficiency, and cost optimization needs. Medius’ proprietary UW Studio™ is a complete underwriting platform delivering the AI revolution that has fundamentally altered the insurance landscape whereby multiple science-based underwriting ensemble models are deployed to address the business and technical requirements by reproducing humanistic deductive actuarial reasoning with clinical accuracy.
Utilization Management Software Guide
Utilization management software is a specialized type of software that helps streamline the utilization review process for healthcare facilities. Utilization management is the practice of managing healthcare resources in order to provide quality care and keep costs down. The utilization management process includes authorizing, monitoring, and evaluating services rendered to patients in order to ensure they receive the care they need without wasting resources or paying for unnecessary treatments. Utilization management software simplifies this process by providing an efficient way to manage requests for services and track the authorization process.
The utilization management workflow typically involves providers submitting service requests, which are then reviewed by staff members using the software’s features. This review may include verifying that the requested treatment is medically necessary and appropriate for the patient’s condition as well as checking if it meets insurance requirements. Once approved, providers can proceed with offering services and begin tracking billing information.
Utilization management software eliminates paper-based workflow processes, making it easier to maintain records while also ensuring accuracy and efficiency in each step of the utilization review process. The software often provides comprehensive reporting capabilities, allowing users to monitor utilization rates over time as well as identify areas where improvements can be made within their organization. Additionally, it may integrate with other systems like billing or claims processing systems to automate certain tasks involved in utilizing services such as eligibility verification.
Overall, utilization management software is a powerful resource that can help healthcare organizations reduce waste and increase efficiency in providing quality healthcare services to their patients.
Utilization Management Software Features
Utilization Management Software provides a comprehensive suite of features to help healthcare providers manage their utilization workloads more effectively.
- Pre-Certification Automation: Utilization management software can automate the pre-certification process by automatically requesting the necessary authorizations from payers and insurers for certain services or procedures. This automation helps streamline the process, reduce paperwork, and save time.
- Claims Status Tracking: The software can track claims status throughout the entire lifecycle of each claim – from submission through payment. This feature helps ensure that payments are processed quickly and accurately, reducing denials and delays in payment.
- Medical Necessity Checker: A medical necessity checker is an automated tool that evaluates submitted claims against standards set by payers or health plans to determine if requested services or procedures are medically necessary under the plan's rules. This feature helps reduce waste and fraud and ensures compliance with payer regulations.
- Coding Optimization: Softwares often include tools that can help optimize coding accuracy when submitting claims to payers or insurers. This feature helps reduce errors in coding, which could lead to denied claims or delayed payments.
- Predictive Modeling: Utilization management softwares typically include predictive modeling tools which allow providers to analyze historical data to anticipate future needs when making decisions about patient care or financial planning for their practice. This feature helps providers maximize efficiency and ensure resources are allocated effectively.
- Compliance Monitoring: The software can help providers monitor claims to ensure they are in compliance with applicable laws, regulations, and payer requirements. This feature provides an extra layer of assurance that providers are meeting their obligations and minimizing their risk of audit or investigation.
Types of Utilization Management Software
- Patient Case Management Software: This type of utilization management software is used to help healthcare organizations manage and track the care of individual patients. It can provide insights into the care process, patient medical histories, and the effectiveness of treatments. It also allows for collaboration between providers, payers, and other stakeholders in the healthcare system.
- Pre-Authorization Software: Utilization management software of this type enables healthcare organizations to easily obtain pre-authorization from insurance companies for certain medical procedures or services. This ensures that payment is received up front and helps to prevent disputes later on.
- Integrated Delivery Network (IDN) Software: Many healthcare organizations are part of a larger integrated delivery network (IDN), which comprises caregivers, health plans, and insurers all working together to provide better quality care at lower costs. IDN software helps coordinate care across these various entities by providing access to data on patient treatment plans, health events, referrals, diagnoses code sets, and more.
- Quality Assurance Software: Healthcare organizations must demonstrate their compliance with federal regulations in order to receive reimbursement from government s like Medicare or Medicaid. Quality assurance software helps ensure that clinical administrators are adhering to accepted standards when it comes to coding procedures and documenting outcomes.
- Resource Utilization Management Software: Resource utilization management (RUM) is a tool used in hospitals and other healthcare settings to analyze their usage of resources such as personnel time, space utilization, equipment utilization rate and patient satisfaction scores within an enterprise setting. RUM tools also allow hospitals and other provider organizations to better optimize resource allocation across their enterprise systems over time based on real-time variability in demand for services.
- Payment Integrity Software: This type of utilization management software helps healthcare organizations ensure that they are being appropriately compensated for the services that they provide. It automates payment-related tasks such as claim scrubbing and validation, prior authorization, fraud detection, and more. Payment integrity software can help healthcare organizations save time and money by reducing administrative costs associated with coding and billing for services.
Advantages of Utilization Management Software
- Improved Clinical Efficiency: Utilization management software allows healthcare providers to increase their clinical efficiency by streamlining the administrative processes for managing clinical utilization. Automated alerts can be configured to track discharge criteria and monitor utilization trends across all providers, so that inappropriate care does not go undetected. This ensures optimal utilization of resources and cost savings for the facility.
- Streamlined Claims Management: Utilization management software reduces paperwork and automates claims processing from eligibility verification to payment authorization. This eliminates tedious manual data entry and makes it easier for staff to quickly review claims, manage appeals, update information in the system, and ensure accurate reimbursement from insurance companies.
- Increased Patient Satisfaction: By reducing wait times at hospitals and clinics, utilizing user-friendly solutions for patient intake forms, scheduling appointments electronically, automatically alerting providers about changes in medication or treatments needed by patients, as well as providing patient access to their health records through portals online or via mobile app – utilization management software increases patient satisfaction and overall experience with the care they’re receiving.
- Enhanced Care Quality: With improved communication between medical teams thanks to electronic medical record (EMR) systems integrated into utilized management software, medical professionals are better able to coordinate care across different departments within a hospital or clinic setting. This allows healthcare organizations to better utilize manpower and resources while providing improved quality of care delivery throughout their networks of practices.
- Cost Savings and Improved Profitability: With automation of administrative tasks like billing reconciliation services and fraud detection as a part of utilization management software technology, healthcare organizations are able to achieve cost savings on overhead costs related with admin activities. This also enables them improve profitability through increased accuracy in data entry due which results in less chances of error related losses due to duplicate entries or incomplete information fields being filled out incorrectly.
What Types of Users Use Utilization Management Software?
- Hospitals: Utilization management software allows hospitals to streamline processes related to patient care, such as documentation, billing, and tracking outcomes. It also helps administrators manage staff resources and determine when additional personnel may be needed.
- Insurance Companies: Utilization management software enables insurance companies to evaluate patient claims more efficiently and accurately in order to determine the most cost-effective course of treatment for their customers.
- Care Providers: The software enables providers to submit claims electronically and track utilization data regarding patient care, test results, discharges or deaths. This information can then be used by providers to better understand trends and adjust practices accordingly for improved patient outcomes.
- Clinics & Medical Practices: Clinical staff can use utilization management systems to monitor quality of care provided in outpatient settings, review medical records for accuracy and completeness, and generate reports detailing activities performed throughout a day or month.
- Government Agencies: Utilization management software is increasingly being adopted by government agencies that actively track usage data for both individual healthcare entities as well as entire populations in order to identify areas requiring intervention on an institutional level.
- Patients: Patients are able to use the software to review their own records; view upcoming appointments; access personal health information; keep up with health plans; communicate with clinicians/providers; refill prescriptions; obtain payment statements; and gain access to educational materials related to their condition or treatment plan.
How Much Does Utilization Management Software Cost?
The cost of utilizing utilization management software for healthcare can vary greatly depending on the specific tool chosen. Some of the factors that can influence the cost include the features included in the software, how many users it supports, and if customization is offered. Generally speaking, basic tools will cost anywhere between a few hundred to a few thousand dollars depending on their features and capabilities. For more advanced tools, which often come with additional features and capabilities such as automated processes or long-term data storage and access, costs can increase substantially up to $50,000 or even more for very large enterprises. Furthermore, in addition to one-time charges associated with purchasing and implementing utilization management software, there may be maintenance fees involved or periodic updates required when new versions are released. Ultimately, the cost of utilizing utilization management software will vary based on the business needs and budget.
What Software Can Integrate With Utilization Management Software?
Utilization management software in healthcare can integrate with a variety of other types of software to streamline processes. For example, medical billing and claims processing software such as those used for electronic medical records, pharmacy benefits management systems, and revenue cycle management solutions can be connected to utilization management tools to ensure accurate patient information is being transmitted. Analytics tools like data mining software can also integrate with utilization management software in order to analyze patient trends and determine the potential impact or financial implications of treatment plans. Additionally, population health management technologies are also able to connect with utilization management platforms to provide insight into how treatments for certain conditions may affect a large number of people so that potential risks and rewards can be explored before committing resources.
Trends Related to Utilization Management Software
- Utilization management software (UM) automates the utilization of healthcare services, reducing costs and eliminating manual processes.
- UM helps healthcare organizations manage care delivery, improve outcomes, and reduce operational costs.
- It helps increase efficiency by streamlining the entire utilization review process from pre-authorization to post-service review.
- UM provides real-time access to data, allowing healthcare providers to make decisions quickly about patient care.
- It can be used in a variety of settings including hospitals, clinics, ASCs, urgent care facilities, home health agencies and other outpatient settings.
- With the use of UM software providers can prioritize treatments based on clinical guidelines or cost savings criteria to ensure quality patient care is delivered in the most cost effective manner.
- Automated medical record capture and integration capabilities allow for efficient transfer of data between systems and different departments within an organization.
- The use of SMART (Submission/Matching/Approval/Review/Treatment) technology helps streamline communication between providers and payers which also expedites the authorization process and reduces paperwork headaches for both parties involved.
- Advanced analytics capabilities provide insight into utilization patterns that can help identify areas for improvement such as advanced disease diagnostics or preventive measures that could reduce medical costs over time.
- UM systems can also be used to identify and reduce potential fraud and abuse by flagging claims that may deviate from normal trends.
How To Select the Right Utilization Management Software
Selecting the right utilization management software can be a daunting task. However, there are steps that you can take to ensure you choose the best product for your needs.
- Identify Your Needs: Start by making a list of all the features and capabilities that your organization needs out of the utilization management software. Consider user experience, data security, customer support, and system scalability.
- Research Vendors: Once you know what you need, research potential vendors who specialize in utilization management software to compare their offerings against your requirements list. Read reviews from other customers and look into case studies or demos to see how each vendor's product works in real-world applications.
- Set Up Demos: Reach out to vendors with questions about their solutions and arrange for live demonstrations or trials so that you can see how the software works firsthand.
- Make Your Decision: After evaluating both user experience and technical factors such as pricing models or infrastructure compatibility, select a vendor whose offering meets both organizational goals as well as usability objectives set forth by users of the system—all while being reasonably priced within budgetary constraints.
- Financing: Depending on the vendor you select, there may be a variety of payment options available for financing your utilization management software. Make sure to go over all available options and make sure to get everything in writing before committing to any agreement.
Following these steps will ensure that you select the right utilization management software to meet the needs of your organization. Utilize the tools given on this page to examine utilization management software in terms of price, features, integrations, user reviews, and more.