utilization Management module

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Configurable, Workflow-Driven 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.

Features Include:


A module that efficiently supports utilization reviews

Provider Portal

A user-friendly website for providers to easily submit and manage authorization requests

Member Hub

Providing a holistic view of the member

Business Rules Engine/
Configuration Tools

Puts the ability to configure and implement program changes in the hands of non-technical users

Comprehensive Dashboards and Reports

Provides users, managers, and program directors a role-based view of the important data and insights to track daily workload and manage the overall program

Integrated Clinical Criteria

Clinical guidelines integrated into the workflow allowing the ability to configure for 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

Contact a Qualitrac Solutions Expert Today!

Qualitrac Modular Solutions

case management module

quality measurement & reporting module

utilization management module