Our Claims360 solution provides an efficient and automated solution for claims adjudication. This system integrates all claims-related data and processes for a 360-degree view of the claims and enables real-time processing and monitoring of claims.
CredsVault offers secure storage and management of sensitive provider credentialing information, making it easier to maintain compliance and minimize risks.
Our WiseLens solution provides advanced data analytics and reporting capabilities to help payers make informed decisions and improve overall operations.
Our Auth360 solution provides a comprehensive utilization management solution that helps payers make informed decisions, improve care quality, and reduce costs.
Our Auth360 prior authorization solution streamlines the prior authorization process, reduces administrative costs, and improves overall efficiency.
CallsDesk is a call center solution designed specifically for healthcare payers. This solution streamlines the call center process and enhances customer service while improving operational efficiency.
MemberDesk is a member portal that provides members with real-time access to their information and benefits and the ability to log disputes and grievances.
Our ProviderDesk solution provides a streamlined and efficient process for managing provider information and interactions, including prior authorization requests and dispute resolution.
Our AI Audit HUB solution leverages predictive analytics and machine learning to identify potential revenue leakage, reduce rework, and improve the payment accuracy of claims.
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Utilization management is an essential aspect of healthcare payer operations. It plays a critical role in controlling costs, improving the quality of care, and enhancing patient outcomes. Utilization management encompasses a range of processes, including prior authorization, concurrent authorization, and retro authorization, which help payers to ensure that members receive the proper care at the right time, in the right place, and at the correct cost.
This process requires pre-approval of a medical service before treating the member. It helps payers to determine if a service or treatment is medically necessary, cost-effective, and in line with the member's benefit plan.
This process occurs when a member is already receiving treatment, and payers assess whether the ongoing treatment aligns with the member's benefit plan and is cost-effective.
This process involves payers reviewing claims already paid to determine if they were medically necessary, cost-effective, and in line with the member's benefit plan.
RSTACK provides comprehensive solutions to help payers manage utilization effectively. Our solutions enable payers to streamline authorization processes, improve the quality of care, and reduce costs. Our platform offers real-time data and analytics and provides actionable insights to help payers make informed decisions.
