In healthcare, timing is everything. That’s why Telligen has implemented a groundbreaking enhancement to our Qualitrac® platform, revolutionizing how medical reviewers access and utilize claims data in 2025.
Medical reviewers have traditionally faced a significant hurdle: making crucial decisions about medical procedures with limited historical information at hand. This often resulted in time-consuming back-and-forth communications with providers for additional documentation. With CMS’s Interoperability and Patient Access Final Rule raising the bar for Medicaid programs’ data exchange capabilities, the need for a more efficient solution became paramount.
Telligen’s answer to this challenge is a sophisticated API integration that connects Qualitrac® directly to claims data warehouses, providing instant access to historical claims information. This real-time solution eliminates the traditional waiting period for monthly file uploads and streamlines the decision-making process.
New Features Include:
- Quick Authorization Look-Up: Users can instantly verify paid units and available balances by simply entering an authorization number
- Comprehensive Claims Search: Advanced search capabilities allow users to explore claims history using multiple parameters, including service dates, procedure codes, and claim status
Impact on Healthcare Delivery
This enhancement represents a significant leap forward in healthcare administration efficiency. Medical reviewers can now:
- Make informed decisions immediately
- Reduce administrative burden on healthcare providers
- Minimize delays in patient care approvals
- Access complete historical data for better-informed decisions
The successful implementation of this feature marks another milestone in Telligen’s mission to optimize healthcare delivery through innovative technology solutions.
For more information about Qualitrac® and its features, please contact Telligen’s Qualitrac Client Services and Implementation team for more information.