Critical Access Hospital Utilization Review

A Technology-driven Approach for Critical Access Hospitals

Critical access hospitals have unique challenges that many other hospitals may not face. With fewer staff and greater revenue sensitivity, Utilization Management teams (or the staff member covering UM) at critical access hospitals do not have time to fight denials, wade through EMR records, or create in-depth reports.

Traditional Utilization Management tools are not tailored to help critical access hospitals with many of these key issues. Fortunately, CORTEX approaches UM from a different perspective - a perspective that better fits the way Critical Access Hospitals operate.

Revenue Integrity 

Utilization management directly impacts revenue by getting cases into the correct status as quickly as possible, expediting the review process, and minimizing denied claims and revenue-at-risk.  

CORTEX helps hospitals get the correct status up front by gathering all of the vital information needed to get the case approved by the payer partner the first time.

Robust Reporting CORTEX has advanced reporting capabilities, giving nurses and executives immediate insight into key trends such as observation rate, conversion rate, and missed inpatient-conversion opportunities. Ad hoc reporting within CORTEX gives your team the ability to track discharge readiness and missed conversion opportunities on a case-by-case basis.

Payer Communication  CORTEX acts as the source of truth on medical necessity for each case in the utilization review process. CORTEX gives both payers and providers access to real-time data to quickly and accurately make decisions based on the case's clinical-merit-aligned analytics and insight.

Reduce Administrative Burden

CORTEX’s machine learning and predictive analytics equips teams with actionable insights for a simplified, more informed utilization review process.  

CORTEX uses artificial intelligence to reduce the manual processes for small multitasking teams with limited capacity to complete case reviews, manage denials, and payer communication. XSOLIS' Analytics analyzes disparate clinical data from electronic medical records so that nurses don't have to.  

Utilization Review for Critical Access Hospitals

A Technology-driven Approach for Critical Access Hospitals

Get More Done with Less

Revenue Integrity

Robust Reporting

Payer Communication

Reduce Administrative Burden