Data-driven collaboration between payer and provider is the new standard.
When providers send clinicals for utilization review by the payer, they often send the entire record. Plan staff must then sift through paperwork and data to complete their own medical necessity review. This mirrored process duplicates inefficiency and leads to friction during approvals and appeals.
What is there was a different way?
XSOLIS' Utilization Review platform, Cortex, acts as a shared framework for case review between payer and provider - backed by AI and analytics focused on the true clinical merit of the case.
Cortex gives payer staff a real-time view of each patient case escalated to them by the payer, expediting the review process while reducing redundancy - all without the need for digging through the electronic medical record.
Cortex opens the door for UM by Exception - cases identified by AI can be automatically and appropriately converted to inpatient. For cases requiring a full review, payer nurses use Cortex's analytics and clinically-driven interface for more consistent level of care decisions and approvals.
With Cortex, payers can reduce abrasion with their providers, improve member experience, and equip their staff with technology that supports their mission.