HEALTHsuite®

A key aspect of managing health care is the ability to properly authorize and monitor utilization of medical services. Through the Authorizations / Utilization Management module, health care organizations can completely automate the process of authorizations and referrals, thus eliminating the manual effort and ensuring accuracy.

In addition, the system supports the entire utilization review process. Embedded clinical criteria and access to complete member history provide the foundation for accurate medical management. HEALTHsuite captures service information in English, and converts them into standard ICD-9, ICD-10, CPT-4, HCPCs coding formats for matching claim processing.

Workflow features automate the entire review process, thus eliminating manual effort and ensuring accuracy. The HEALTHsuite system supports unlimited comments with the ability to protect medical comments from view of unauthorized users. Time-saving features, such as the ability to copy services and extensive search capabilities that allow full-text descriptions or code values to be used, reduce user effort and administrative costs.

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