Make sure the right cases are seamlessly handled at the right time, by the right staff, with a shared framework for concurrent authorizations across providers and health plans that leverages AI and ML-driven predictive analytics focused on the true clinical merit of every case.
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Faster Workflows
Aligned P2Ps
More Efficient through First Touch Status Determinations
Cut Review Time, Boost Collaboration
Give all teams secure, real-time access to standardized clinical data in an EMR-agnostic view that eliminates phone calls and faxing, streamlines concurrent authorizations, and speeds end-to-end case review for providers and health plans.
Automate Decisions with Trusted Data
Leverage the Care Level Score™ powered by 300M+ encounters to automate aligned Inpatient and Observation determinations. This automation reduces case touches, minimizes administrative work, and accelerates decision-making.
Focus on Cases That Matter
Agree on shared thresholds to automate straightforward cases and dedicate attention to complex ones improving collaboration, reducing friction, and fostering stronger payer-provider partnerships.
Access payer reviews instantly without manually submitting records. Eliminating fax, phone, and email allows reviews to move faster, turnaround times to improve, and a reduction in preventable denials due to missing or late information.
Reduce manual reviews and stay informed with real-time notifications. Timely updates improve alignment on cases needing a P2P and keep both sides aligned on case status.
Agree on data-driven thresholds to increase determination alignment, reduce medical necessity denials, and manual reviews. Shared criteria mean fewer disputes and more efficient utilization review.
Reduce manual reviews and stay informed with real-time notifications. Timely updates improve alignment on cases needing a P2P and keep both sides aligned on case status.
Agree on data-driven thresholds to increase determination alignment, reduce medical necessity denials, and manual reviews. Shared criteria mean fewer disputes and more efficient utilization review.
Healthcare spending continues to rise, with a large share devoted to administrative tasks. Inefficiencies due to limited transparency and poor communication slow down processes, drive up costs, and create friction among stakeholders. AI-powered collaboration tools can streamline workflows and accelerate case determinations, helping prevent avoidable claim denials, reduce denial-related write-offs and losses, and ultimately support better care and improved outcomes for members.
Learn how Xsolis is using Dragonfly®, its AI-driven proprietary platform, to perform real-time predictive analytics to continuously assign an objective medical necessity score and assess the anticipated level of care for every patient.
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George Renaudin
President, Insurance Segment, Humana
Healthcare organizations face mounting challenges in accessing clinical data for critical tasks like risk adjustment, quality improvement, care management, concurrent authorization and payment integrity. Traditional methods of data retrieval—including faxes, […]
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Do you dream of a day when a provider and a payer are partners and not adversaries – a day when payers complement the provider’s work at the beside instead […]
Read MoreMove past the status quo. Replace competition between provider and payer with end-to-end collaboration and partnership. Learn how.
Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ongoing healthcare services to ensure the patient is receiving the right level of care, at the right time, in the right setting. Concurrent reviews support efficient, cost-effective treatment by assessing whether continued care remains justified.
Automated case reviews use AI and a shared framework to align on medical necessity. This automation reduces delays, increases decision accuracy, and eliminates administrative burden, improving results and processes for payers and providers.
A payer concurrent authorization solution streamlines real-time patient case reviews by aligning and automating decisions between health plans and providers. It improves alignment, reduces delays, and ensures that care is approved based on clinical merit using real-time data and AI-driven tools.
Payer case review automation improves speed and consistency by applying AI to shared patient data, from the EMR. It minimizes manual reviews, accelerates determinations, and ensures every case is reviewed using the same clinical standards across organizations.