Automated Referrals Help Your Staff Take Control of UM
Access Express offers a new approach to utilization management that
will help your organization take control of routine referrals and
authorizations so your medical staff can focus on the more challenging
requests.
Our protocol tables and authorization guidelines work together to
automate the entire UM process. This automation makes the process:
- less burdensome to
providers
- more responsive to patients
- more efficient for the UM
staff to manage
Our medical directors have created a library of
hundreds of useful protocols and guidelines that can be customized to
meet the utilization management criteria of your organization. More
than twenty parameters can be used to define a protocol.
Futhermore, each
protocol can be linked to guideline questions that appear onscreen
when specific types of authorizations are requested by physicians. For example, allergy referrals can generate reminders for
antihistamine, dermatology referrals can inquire about cosmetic vs.
medical problems, and out-of-network referrals can require information
on why the requested service can only be provided outside the regular network.
Authorization requests that are not automatically approved through
protocols and guidelines are forwarded to UM work queues for review by
nurses and medical directors that can be on-site or off-site. These requests
can be directed to specific reviewers for a region or type of request, or
forwarded to a general work queue where groups of requests, like
emergency notifications, can be prioritized.
