Best Utilization Management Software

An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims.

Therap is the industry leader in providing electronic records and documentation in long-term care services for people with Intellectual or Developmental Disabilities. Therap is a web-based application suite that was designed to provide a comprehensive solution for the planning, documentation, reporting, communication and billing needs of organizations supporting people with intellectual and developmental disabilities in home and community-based services (HCBS) and other settings. Using secure cloud technology, the Therap system improves the quality of service within day programs, assisted living facilities, ICF/IID facilities, community support programs and state organizations. Daily communication and reporting between the states, administrators, health care professionals, case managers, quality assurance teams and families becomes seamless.

VitalHub’s portfolio of Patient Flow, Operational Visibility & Patient Journey Optimization solutions are designed for complex hospital and integrated health environments. Our technologies empower frontline teams, clinicians, and leadership to improve patient experiences and achieve higher levels of operational efficiency, resulting in safer care for patients. We deliver solutions which optimize patient flow, perioperative care, demand & capacity, virtual consultations, clinic management, and the patient journey. VitalHub solutions improve transparency and communication through real-time whole system visibility, Integrated information for coordinated care, and optimization of patient movement. VitalHub’s EHR suite of solutions go beyond standard clinical data collection, our solutions provide a comprehensive, holistic view of patients and clients at the point of care.

TreeAge Pro is the leading tool for building decision trees, Markov models and event-based simulations. TreeAge Software, LLC has been a beacon in decision analysis and health economics for over 30 years. Our team of scientists, engineers, trainers and support associates have grown and developed alongside the decision analytics community to build and refine our flagship software – TreeAge Pro. TreeAge Software, LLC is a privately held company headquartered in Williamstown, Massachusetts. TreeAge Pro is the leading visual tool for creating and analyzing decision trees. Create decision trees of unlimited complexity for any type of decision. TreeAge Pro software is used in a wide array of industries, including healthcare, legal, oil & gas exploration, management consulting, investing, teaching, etc. TreeAge Software has earned the trust of more than fifteen thousand modelers globally, including in the US, Europe, Latin America, Asia, Australia and Africa.

The need for integrated solutions and access to knowledge is essential, as technology evolves and therapies become more sophisticated. As your full-service partner, we support you through the entire clinical pathway, so that you can continue to provide excellent care, without ever compromising on quality and safety. Whether you are producing the cures of today or discovering the cures of the future, preventing contamination from occurring is the common challenge. We are there to support you in ensuring a productive and contamination-free research or production environment. Advanced medical equipment needs the combination of smart financial solutions and preventive service maintenance to ensure maximum uptime. We offer you full cost control and peace of mind, allowing you to focus on what's important, saving lives. As a leading medtech company, we focus every talent and resource towards helping our customers save as many lives as possible.

Coordinating care, evaluating and demonstrating quality, identifying risks, and monitoring compliance all require data from multiple sources and systems — and all are key to improving the patient and provider experience. ​ ​Midas Health Analytics improves operational and clinical performance with solutions that manage risk, control cost, and turn data into actionable insights.​ Track and trend performance over time, proactively manage and mitigate risk, make data-driven decisions amid constant regulatory changes, and elevate and foster a safe care environment for all. ​ ​Reach unprecedented operational efficiency when evaluating, interpreting, and demonstrating quality of care performance results to stakeholders in today's complex healthcare ecosystem.

Many hospitals, ambulatory surgery centers (ASCs) and health systems experience significant procedure documentation challenges. Most physician documentation methods, including dictation, transcription and EMRs, lack standardization which can lead to inaccurate, incomplete and non-compliant procedure notes. The resulting reports are not searchable or easy to analyze because they are built with unstructured data. Not to mention, insufficient, tedious workflows lead to financial losses and frustrated physicians. Guides physicians through an intuitive workflow navigation tree to offer appropriate selections for quick documentation. Helps organizations meet quality and compliance standards by allowing users to run over 100 reports and analyze structured data reports. Connects directly with endoscopy scopes to collect all relevant images and add them to procedure notes.

A new category of utilization management software, CORTEX provides a 360° approach to addressing the intricacies of utilization management and revenue cycle processes. Powered by real-time predictive analytics and machine learning engine, CORTEX ensures that the right cases are handled at the right time, by the right staff or by exception. CORTEX incorporates precision medicine upon a foundation of evidence-based medicine. Machine learning models operate in real-time to better assess your patient population. Our analytics have been deployed in hospitals and health plans across the nation. With clear inpatient cases, CORTEX does the heavy lifting by automating inpatient determinations on cases that meet your unique threshold. For difficult cases, CORTEX offers your staff the insight they need to make a strong determination. This approach offers incredible value to payers and providers alike.

Privacy-safe DTC and HCP segments that are higher in audience quality and drive greater lift over conventional targeting approaches. Every therapy is specialized and each brand is unique so we don’t believe in traditional condition-based segments. We seek to understand your challenges and business goals when designing custom audiences. Whether you are a market leader, a new entrant facing adherence challenges, or planning to execute a multi-product strategy, we can help you drive results. We maintain the industry's highest standard of performance markers as validated by third parties. And if you reveal your Audience Quality (AQ) benchmark upfront, we guarantee to meet or exceed it. Higher AQ drives greater engagement, optimizes conversion, and ultimately increases script lift, as well as boosts therapy adherence and thus patient lifetime value. We ensure 100% compliance with all laws, policies and guidelines.

Specialty and rare diseases have undefined patient populations, with individuals who are undiagnosed or misdiagnosed, healthcare providers who are unaware of disease states and their manifestations, as well as treatment journeys that are not well understood. IPM.ai is an Insights-as-a-Service (IaaS) company that empowers the world’s leading life sciences brands to better understand and improve the lives of patients through the development, clinical study, and commercialization of therapeutic interventions. Maximize commercialization efforts by forecasting market size, competitive landscape, and potential ROI. Uncover ideal patients who are undiagnosed and/or misdiagnosed who may be appropriate for disease interception and therapeutic intervention. Statistically model the number of disease cases present in a particular patient population at a given time. Identify physicians who diagnose and treat ideal patients and influence other health care providers.

The tools of the SMAF finally reunited in a single shareable information system. Automatic calculation of the SMAF profiles. Reports facilitating the analysis of results and the development of the assistance plan. Simple and easy to use by the health care professionals. Facilitates networking and service organization. No need for software installation. The iSMAF, the fifth major release of our software, is a web software that computerizes proven clinical tools and processes supporting the SMAF tool. The iSMAF edition for Quebec includes the PRISMA-7, the SMAF evaluation grid, the social-SMAF, the Iso-SMAF profiles generator, and the care table. It also includes several functions allowing clinicians and managers to generate various reports on subjects or on groups of subjects. It is, therefore, possible to obtain an overall picture of the establishment, the evolution of profiles, or of one SMAF item through time, or to compare the profile distribution among different subject groups.

Lightbeam provides population health enablement by transforming insights into outcomes. Closing care gaps and minimizing risks. Improving quality of care and quality of life. Lightbeam’s proven population health management platform transforms disparate data into a full 360-degree patient picture, bringing true value to value-based care. In today’s value-based care model, managing risk begins and ends with data intelligence. Lightbeam’s powerful population health management platform pulls patient data together in unprecedented ways, unlocking the value that comes from deploying the right data in the right place at the right time. Lightbeam isn’t just revolutionizing how our clients manage value-based care. It’s proving to be a game changer in driving results and saving our clients over 2 billion dollars since 2014 and we’re just getting started. Lightbeam’s tech-enabled services approach seamlessly supports these efforts.

We help to improve the performance of thousands of healthcare facilities worldwide, as well as the experience of their staff and patients. A solution that optimizes ambulatory care pathways to bring patients peace of mind. LGI eClinibase increases patient care pathway visibility and reduces waiting times by disseminating information on each episode of care. Eliminate paper and quickly access data on referrals, wait lists, and appointments. Lists and summaries of all episodes of care from one or more clinical administrative systems. Management of referrals, appointments, and patient communications for the entire facility. Management of referrals, appointments, and patient communications for the entire facility. Automatic suggestions for corrections to patient records and duplicate matching. Management of the professional activities agenda (intake management, appointments, clinical documentation, and statistics for the MSSS).

Equip your healthcare team with clinical-decision support software that takes the guesswork out of capacity management across the entire hospital. This evidence-based, clinical-decision support system tool helps your facility increase bed turnover and improve the patient experience. Harness the power of predictive analytics and better data to improve care coordination and patient satisfaction. The hospital bed management system provides care teams with visibility into the status of each patient’s journey and enables bed demand and capacity management across the hospital, or from multiple sites within a healthcare delivery system. Empower your physicians, nurses, and clinicians with software that eliminates clinical subjectivity and standardizes data collection. Medworxx generates predictive analytics to leverage data that anticipate trends and provides healthcare professionals with smarter data.

Through valuable partnerships and experience, Envolve drives real healthcare transformation through value-based, affordable care solutions. Envolve MSO services provide organizations with the strategies, people, and processes necessary to provide value-based, affordable care and drive real healthcare transformation. As a leading healthcare management services provider, we bring innovation, experience, and resources to help drive performance in outcomes-focused and value-based reimbursement models. Our healthcare management services allow for better healthcare and efficiency in the delivery of care through best-in-class business administration services, data utilization, clinical excellence, and operational support. Envolve brings significant experience investing in innovative benefit designs for numerous products throughout the country for publicly funded, marketplace, and commercial programs that positively influence individuals' health and quality of life.

With an innovative suite of solutions and the most interoperable care collaboration network, we are realizing a vision of whole-person care that’s shifting expectations and revolutionizing healthcare. Enabling more informed decision-making and better outcomes starts with a promise, a promise to continue listening, collaborating, and disrupting. It’s the heart of our vision and the reason we are able to drive powerful results across all settings of care. Decide on the right care options and act with certainty with real-time insight and the largest care collaboration network in the nation. Quickly identify the optimal path forward with lightweight solutions that streamline workflows and expedite patient care. Reduce risk, lower costs and accelerate the adoption of value-based care with access to proactive intelligence that until now has been unavailable. Make whole person care a reality with valuable context that includes both physical and behavioral health experiences.

Making the front end your first priority. Integrated front-end solutions to improve patient financial experience and revenue cycle results. Determine address deliverability, minimizing returned mail and unpaid invoices. Reduce input errors by confirming patient identity and demographic information. Verify patient insurance eligibility at the point of service. Maximize revenue and regulatory compliance by verifying medical necessity before service. Automate PA end to end in just seconds. Automate the notification process to ensure timely notice of inpatient hospital admittance to payers. Promptly and accurately communicate patient out-of-pocket expenses. Increase collections by determining propensity to pay and financial aid eligibility. Once overlooked, patient access has become a driving force in hospitals. Our flexible platform provides a powerful synergy of integrated information from multiple verification sources combined with intelligent guidance.

FIT eLearning is a new, accelerated, way to learn and implement feedback-informed treatment. Based on the ground-breaking PCOMS evidence-based practice, FIT eLearning is designed to help you gain capabilities and confidence regardless of your learning style. Excellent understanding of PCOMS and FIT. A meaningful outcome and session rating process for clients. Adoption of a simple red, yellow, and green signaling system to keep sessions on track. An ability to map your clinical effectiveness across clients. Identification of your professional baseline. The ability to measure micro improvements in future skills growth. A certificate for 12 hours of online psychotherapy training in feedback-informed treatment. Whether you’re an individual practitioner or part of a larger organization, FIT eLearning helps you develop a culture of feedback and incorporates the outcome and session rating scales (ORS & SRS) into your clinical practice.

Our industry-leading, artificial intelligence (AI)–driven technology converts both structured and unstructured healthcare data into a high-quality, reliable, standardized dataset that can be used across your organization. Accessing data in near real-time from disparate systems, our products and services reduce the burden of manual data abstraction so your administrative and clinical teams can recapture that time for quality and research initiatives. Our products and services allow you to collect, analyze, and act on your data, regardless of data source, therapeutic area, organizational department, or existing reporting, BI, or analytics tools. Atlas uses human expertise and the power of AI to automate and simplify the resource-consuming task of finding and interpreting patient data for clinical registries. Cartographer searches, analyzes, and interprets patient data across all platforms, standardizes those data into a consistent format, and provides relevant data recommendations.

CareStat is SHP’s comprehensive post-acute analytics solution that unites acute care providers, ACOs, payers, and physician groups with skilled nursing facilities (SNF) and home health agencies (HHA). Our goal is to jointly advance the management of patient outcomes, operations, utilization, and post-acute provider partnerships. In addition to SHP’s proprietary readmission algorithms, CareStat uses real-time OASIS (HHA) and MDS (SNF) data, to support patient management across the continuum of care. Reduce readmissions and lower length of stay. Enhance collaboration and partnership efforts. Improve referral patterns and patient satisfaction. Save time by simplifying data transfer of quality and outcome metrics. When it comes to managing trends in a numbers-driven industry, your organization knows the importance of actionable insights. Your initiatives require the proper tools and know-how to operate at peak efficiency.