Xsolis Unveils UM by Exception Portal for Payers and Providers

Without a common framework for determining medical necessity that is intuitive to clinical staff and informed by clinical decision-making, reimbursement and care remain misaligned. Xsolis, the company using real-time predictive analytics to transform healthcare operations, today introduced the XSOLIS Partner Portal, which serves as a neutral framework for care determinations between providers and participating payers nationwide. Providers utilizing the Xsolis platform are now able to streamline communications with their payers through the Portal, enabling both parties to assess appropriate hospital-based care through data-driven determinations of clinical merit.

Xsolis eliminates inconsistency through its unbiased real-time predictive analytics, which offers a neutral and objective foundation for collaboration and consistency. With XSOLIS analytics forming the source of truth between hospitals and insurers, utilization management can be undertaken through a ‘by-exception’ model – reducing duplicative effort and heightening productivity for each organization. This framework promises to increase compliance, mitigate revenue risk, and create alignment within the payer-provider relationship.

“Xsolis’ analytics platform enables our staff to more effectively review patients’ clinical conditions and provides supporting documentation for defensible medical necessity determinations as well as case reviews,” says Sherri Ernst, Revenue Integrity and Utilization Management Officer for Covenant Health. “Now that we’re able to escalate that information directly to participating payers prior to discharge, we are more aligned on clinical merit for each patient and less likely to experience a denied claim due to missed clinical information necessary to support medical necessity.”

“By using predictive analytics to aid both payers and providers during case review, we can help hospitals and insurers lessen their administrative burden and costly adjudication efforts and most importantly – create a common ground for critical decisions,” said Joan Butters, CEO and co-founder of Xsolis. “Patient care is too important to let the current state of inertia and inefficiency remain a reality.”

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