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XSOLIS' Utilization Review platform, CORTEX®, acts as a shared framework for case review between payer and provider - backed by analytics focused on the true clinical merit of the case.
CORTEX for Payers gives payer staff a real-time view of each patient case escalated to them by the provider, expediting the review process while reducing redundancy - all without the need for digging through the electronic medical record.
Hospital and payer teams have secure access to specialized, EMR agnostic views for standardization of clinical reviews
Payer staff have a real-time view of each member case, expediting the review process while reducing redundancy - all without the need for diffing through the electronic medical record.
When analytics are above a certain threshold, payer and provider agree to automated inpatient and observation approval. We call this Precision Utilization Management. You might expect:
Healthcare can’t remain a zero-sum game. XSOLIS CEO Joan Butters recently joined Humana SVP George Renaudin for an in-depth discussion on the state of today’s payer-provider relationships.
Their conversation covers three themes: zooming out to the status quo and why it can’t stand; zooming in to what XSOLIS and Humana are doing to transform the discipline of utilization management; zooming back out to how the industry can adopt this forward momentum.