Best Government Utilization Management Software

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.

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.

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.

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.

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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:

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.

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.

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.

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.

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.

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.

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.