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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Prior authorization is a crucial process in the US healthcare system. Healthcare providers or members must obtain approval from their health insurance plan before administering a specific medication or medical procedure. Failing to obtain prior approval can result in the patient being responsible for the entire bill, as the insurance may not cover the services. Auth 360 eases this process and improves the prior authorization experience for all stakeholders - members, providers, and payers.
Prior authorization (PA) issues are associated with 94% of care delays and contribute to patient safety concerns and administrative inefficiencies. According to a survey report published by the American Medical Association (AMA), 90% of physicians reported that PA programs hurt patient clinical outcomes. Only 15% of the respondents agreed that PAs were often based on evidence-based medicine. The manual processing of 87% of PA submissions, operational and administrative costs, and poor member and provider experience are significant challenges the industry faces.
End-to-end Auth Intake process
Electronic PA request submission through a portal
Configurable rules for accurate and relevant process checks
Outreach efforts, including fax, correspondence, follow-ups, alerts, and notifications
Peer-to-peer review capability for a one-on-one discussion between provider and RN/CN/MD
Uber model-based skilled resource onboarding for cost-effective staffing
Streamlined prior authorization process
Reduces manual processing and eliminates potential revenue leakage
Improves TAT by streamlining the prior authorization process
Improves member and provider experience by reducing care delays and administrative inefficiencies
Reduces operational and administrative costs
Increases compliance with policies and procedures, and regulatory norms
Supports evidence-based medicine criteria for prior authorization decisions
Provides a cost-effective solution for staffing skilled resources
