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MedHOK's Utilization Management Solution
Home / Solutions/ Medical  / Utilization Management

Utilization Management Solution

Solution Overview

MedHOK’s Utilization Management component comes out-of-the-box with Medicare-compliant fields and drop downs to ensure CMS compliance, and is easily configured for other lines of business. The component includes multiple intake channels, auto-population of eligibility data, and structured workflows, tasks, and work queues triggered by business rules to ensure consistent applications of rules, requirements, and medical necessity standards. MedHOK is fully integrated with both MCG and InterQual clinical criteria, and can accept business clinical criteria.

Customers use this solution to:

  • Simplify the review process for members and providers resulting from a medical prior authorization
  • Create custom auto authorization rules
  • Send correspondence and effectuate approvals in the claim systems
  • Provide a central location of medical documentation for plan review to make efficient clinical determination on prior authorization

Have You Considered ...

 

With Utilization Management, you may also want to manage related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these MedHOK solutions:

Download Product Spec Sheet

100% Out-of-the-Box Compliant

Ensure compliance day 1 with MedHOK. Our Platform is 100% compliant with Medicare, Medicaid, and Commercial/Exchange rules and regulations

Fully Integrated with MCG and McKesson

With the integration of Milliman Care Guidelines CareWebQI® and McKesson InterQual and Integrated Coordinated Care Content, MedHOK delivers tools for better clinical decision-making

Workflows Based on Industry Best Practices

Automate processes per your business rules and industry best practices to improve productivity and ensure compliance

Request a Demo

See How the Industry's Biggest Health Plans Use MedHOK's Utilization Management Solution

Please complete the form and let us know which capabilities you would like to see.  One of our demo specialists will contact you to conduct or schedule your custom demo.

UM Demo Request