utilization management Module
Telligen’s Utilization Management Solution efficiently manages the review process, promoting quality care and reducing unnecessary services. This solution eases the administrative burden for providers and staff, contributing to cost-effective healthcare management for our clients. Through integrated clinical criteria, we are able to automate authorization decisions, streamlining the process effectively.
Utilization Management Module
Telligen’s Utilization Management Solution efficiently manages the review process, promoting quality care and reducing unnecessary services. This solution eases the administrative burden for providers and staff, contributing to cost-effective healthcare management for our clients. Through integrated clinical criteria, we are able to automate authorization decisions, streamlining the process effectively.
Module Features
Workflow-driven to efficiently support utilization reviews
User-friendly provider portal for submitting and managing requests
A holistic view of the member available via the Member Hub
Give non-technical users the ability to configure and implement program changes with the Business Rules Engine
Comprehensive Dashboards and Reporting gives users a role-based view and insights for managing the overall program
Clinical guidelines integrated into the workflow for providing automated authorization decisions
EHR Integration:
- Compliance with the CMS Interoperability and Prior Authorization Rule
- Integrated with providers’ EHR for seamless, automated PA and UM service requests
- Leveraging FHIR-based API data standards for easy implementation and lower costs
- Reduces provider burden – elimination of portals, faxes and phone calls
- Reduces payer burden – returns EHR data specific to service request, reducing nurse time and requests for additional information
- Improves member experience – timely, accurate decisions for receiving care
Built-in Assessment Scheduling
- Outreach queue identifies members with an assessment need and provides filtering and sorting options to prioritize outreach activities
- With a single button click the Qualitrac system sends correspondence to the member regarding the assessment scheduling and notifies the case manager electronically of the request for information
- Case Managers utilize the Qualitrac portal to provide pertinent information to facilitate the scheduling of the assessment interview – this can include respondent information, interview location, date and time as well as member needs and capacity
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Qualitrac Modular Solutions
case management module
quality measurement & reporting module
utilization management module
