Telligen is excited to announce its update on enhancements made to our latest Qualitrac release (2023.04). Our clinical and technical experts work year-round to enhance and advance the product, which is how we’re able to help our clients achieve their goals for quality and outcomes improvement, and cost savings.

Case Management Enhancements

In collaboration with case managers, providers, and members we have continued development of our Qualitrac Case Management module to support a comprehensive person-centered care coordination process by combining innovative technology and user-friendly design. Case Managers, members, providers and community-based organizations can all collaborate and communicate throughout the lifecycle of the Case Management process utilizing our Person-Centered Service Plan (PCSP) wizard, chat messaging, referral intake flow and more.

Using the wizard, Case Managers can focus on working through individual focused sections of the plan and step through them one at a time. This incremental approach helps to break the plan up into smaller meaningful sections, but when combined creates one robust person-centered service plan. The core sections to the plan include the following:

  • PCSP Information
  • Member Information
  • Risk Factors
  • Action Plan and Goals
  • Services and Supports
  • Crisis and Safety Plan
  • Behavioral Health Support Plan
  • Rights and Restrictions
  • Education and Employment
  • Acknowledgements and Signatures

Utilization Management Enhancements

InterQual Integration – Qualitrac is now certified and fully integrated with Change HealthCare’s InterQual® Medical Review Service Version 2.0. This integration provides our Utilization Management clients with options when choosing what clinical guideline vendor they would like to utilize as part of the review process.

Dental Reviews – Multiple updates to our dental review process to collect additional data elements and address the handling of duplicate requests.

  • New fields added – Tooth number, quadrant and surface.
  • Duplicate Dental Request Handling – Development of an algorithm and client preference to identify if a duplicate dental request should be allowed or not.

Multiple Modifier Support – Qualitrac is now configured to allow up to four modifiers to be added to a given requested procedure, if applicable.

Manual Pricing Indicator – The Manual Pricing feature, available in the Outcomes panel on the UM review page, is now configurable to display based upon the client review type, place of service, and type of service combination. This indicator allows reviewers to indicate a manual price for scenarios where a rate or price that differs from the usual and customary or fee schedule may be necessary.

Certified Mail Configuration – New configurable option to send correspondence via certified mail, including visible tracking link from USPS within the Qualitrac system.

Assessment Management Enhancements

New Assessment Comparison Tool Enhancements – New functionality was added to the assessment comparison tool that allows end users to compare groups of questions and answers between assessment responses.

Contact Center Enhancements

Enhanced Member Support – We’ve optimized the support experience for both members and providers through distinct inbound call experiences with the system ensuring they only encounter options relevant to them. Additionally, the member-focused messaging during hold times aims to provide relevant and targeted health information and reminders, enhancing the overall support and engagement for healthcare services.

Agent Assist/Smart Scripts – Transcribes conversations in real-time, enabling agents to stay informed about customer interactions and emphasizing crucial points. This tool seamlessly searches the knowledge base for optimal responses to customer inquiries, streamlining the process for agents who no longer need to navigate multiple applications. Moreover, it offers real-time conversational guidance and automates business processes. The implementation of Smart Scripts delivers a virtual agent experience, ensuring consistent and reliable support across all calls.

After Hours Virtual Agent Transcript and Recording for New Cases – Significantly cuts down on transcription time, saving agents hours on documentation and enabling them to respond to callers promptly. This virtual agent operates after regular hours and efficiently gathers necessary information from callers to create cases. It not only transcribes the responses but also generates audio recordings for each request. This streamlined process enhances efficiency in case creation, providing a seamless and time-saving solution for handling new cases outside of regular business hours.