When Providers send clinicals for review by the Payer, they often send the entire record. Payer staff must then sift through vast amounts of paper and data to complete their own medical necessity review. This manual process mirrors that of the Provider and creates duplicative inefficiency and wasted time.
In addition to the manual nature of the Payer review, it can also be inconsistent, due to the variations in skill, judgement and expertise of each nurse to effectively find and interpret clinical support within the medical record.
Our data-driven analytics allow payer nurses to view the same analytics around each patient’s clinical condition, enabling more consistent level of care decisions, expediting case reviews overall and creating greater alignment with providers. These analytics also create opportunity for a true UM by exception model.
Our Payer Portal creates a single system where both parties are able to perform all UM activities with a real-time view of the patient and communicate with one another to expedite the review process while reducing redundancy.
With XSOLIS' predictive analytics forming the source of truth between hospital and insurer, utilization management can be undertaken through a ‘by-exception’ model, with both parties eliminating the need to individually review a subset of patient cases.
Providers utilizing the XSOLIS platform are able to escalate patient cases to their payers through XSOLIS' Payer Portal, eliminating duplicative work during case review and enabling both parties to assess and approve appropriate status and care pathways.
By using our predictive analytics during case review, both providers and payers become aligned on the medical necessity of each case. XSOLIS helps insurers lessen their administrative burden and effectively manage care utilization for each patient.