For many healthcare systems, Utilization Management has shifted from a patient-centered service to an administratively frustrating body of work.
CORTEX is the answer. It is a breakthrough in healthcare software systems.
CORTEX is a utilization review software system that starts with real-time EMR data and centers on predictive analytics. This ends in a technology platform that gives hospital staff a clear view of medical necessity for each patient.
CORTEX also acts as a conduit with your payer partners, enabling a new level of collaboration and communication. Through health system utilization management, we are able to achieve far better results.
Improved EfficiencyTraditionally nurses start at the top of their daily census and work their way down. They treat the daily census as an all-or-nothing approach. They give all cases an equal priority. To aid this, what they need is patient case management software. CORTEX, a utilization review software, uses AI and machine learning to identify cases that are most likely at risk. This helps nurses spend more time on the cases that actually need the most support.
Currently, the average CORTEX client sees a 30% efficiency gain. |
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Better Payer CommunicationsCORTEX makes payer relations seamless and collaborative. With CORTEX, payers and providers see all of the patient’s data per encounter in real-time. This negates the need for faxes, emails, or phone calls. CORTEX acts as the source of truth for medical necessity in each case. It offers a shared framework of analytics and insight.
Up to 40% of inpatient cases can be automated with 99% accuracy. |
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Inpatient ConversionCORTEX uses XSOLIS Analytics to give recommendations on the appropriate status of a patient. This is based on the patient’s labs, vitals, medical history, orders, meds, and procedures. In some cases, the recommended status is different from the assigned status. At this point in time, the UR team will be notified of the conflict and empowered to take action. This makes CORTEX’s medical utilization review software crucial to both good care and good administration.
An appropriate Observation rate reduction of 8.7% is typical for CORTEX users in their first year. |
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Denial Risk |
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A denial costs the hospital valuable revenue. It wastes the time of the physician advisor and can lead to a cycle of appeals. CORTEX uses evidence-based medicine to help find patients set as INPT. It cross-checks to see if they have the clinical documentation to support their in-patient status. CORTEX gives real-time alerts when a patient’s status does not align with the clinical merit. This gives your staff the insight they need to prevent downstream denials.
CORTEX users can benefit from an average 32% denial reduction. |
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Below you'll find select resources aimed at supporting and informing health system leaders - from supplementing the role of the physician advisor to adopting centralized review to reframing payer relations through analytics, schedule a demo today to learn how XSOLIS can support you.
CASE STUDY
Covenant Health (9 hospitals)
Covenant Health not only transformed their UR, but how they collaborate with payers on utilization management.
WEBINAR
AI in Healthcare: The Benefits to UR
AdventHealth in Florida shares how they are using artificial intelligence to support utilization review and physician advisor staffs.
VIDEO
Mark Roberts, Banner Health
Mark Roberts, Director of Care Coordination, shares his experience at the XCHANGE conference and with the CORTEX platform.
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