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 treating the daily census as an all-or-nothing approach, giving all cases an equal priority. CORTEX uses artificial intelligence and machine learning to identify cases that are mostly like at risk to help 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 
• Helps standardize workflows
• Patient data flows from the EMR directly into the platform.   

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 without the need for faxes, emails, or phone calls.  CORTEX acts as the source of truth for medical necessity on each case, offering 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 are statused upfront, expediting the review process 

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

Inpatient Conversions

CORTEX uses XSOLIS Analytics to give recommendations on the appropriate status of a patient based on the patient's labs, vitals, medical history, orders, meds, and procedures.  If the recommended status is different from the assigned status, the UR team will be notified of the conflict and empowered to take action.

• 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, wastes the time of a physician advisor, and can lead to a cycle of appeals.  CORTEX uses evidence-based medicine to help find patients set as INPT that may not have the clinical documentation to support Inpatient status.  CORTEX gives real-time alerts when a patient's status does not square with the clinical merit, giving 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​” 

32% Denial reduction is common for many CORTEX users.