Automating provider steps in authorization and utilization management (UM) processes reduces provider abrasion and gets members the services they need more quickly. Having an authorization automation solution in place can help lower costs while improving quality of care. CareAdvance Provider®, working in tandem with Clinical CareAdvance®, creates a pre-integrated connection between health plans and physician offices to automate the authorization process. Pre-integration with Clinical CareAdvance makes provider and member data available in real-time, and Clinical CareAdvance’s integration with core administration systems’ care management functionality enables a fast and automated exchange of information even further.
CareAdvance Provider enables the following key capabilities for health plans and their providers:
- Automatic, real-time authorization request and response
- Replacement of time-consuming, inefficient phone-based and fax-based requests
- More effective management of inpatient and outpatient utilization costs
- Flexible configuration to automatically accommodate specific provider needs
- Add, view and extend inpatient and outpatient authorization requests for services