Maximize Your Healthcare System's Utilization Management Impact

Improved Efficiency

Traditionally 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.

• ​Nurses can start on high priority, high-risk cases to best utilize their time. 
• CORTEX standardizes workflows.
• Patient data flows from the EMR directly to the platform.  

Currently, the average CORTEX client sees a 30% efficiency gain.

Better Payer Communications

CORTEX 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.

• Gets payers and providers on the same page using the same tool.
• Significant reduction in case touches, administrative work, and appeals burden.
• Cases show statuses upfront, expediting the review process.

Up to 40% of inpatient cases can be automated with 99% accuracy. 

Inpatient Conversion

CORTEX 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.

• 24/7 monitoring of all patient information.
• Find inpatient opportunities as soon as the patient demonstrates clinical merit.
• Identify opportunities earlier in the shift to allow time for resolution.

 An appropriate Observation rate reduction of 8.7% is typical for CORTEX users in their first year. 

Denial Risk

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.

• Automated presentation of patients’ conditions. ​ 
• Data-driven evidence-based medicine​. 
• Real-time alerts for status “discrepancies​”.

CORTEX users can benefit from an average 32% denial reduction.