Manage Private Insurance Utilization and Reduce Fraud, Waste and Abuse
Private Insurance Utilization Management Software Simplifies Compliance
Private Insurance
Netsmart private insurance utilization software helps organizations reduce fraud, waste and abuse. The web-based solution integrates with more than 100 electronic health records (EHR) and electronic visit verification (EVV) apps to aggregate data across providers. As a result, organizations can check compliance with prior authorizations, verify compliance and analyze service delivery without time-consuming manual reporting.
Private insurance claims adjudication technology pre-screens, scrubs and provides all claims submissions in a standard format. The solution shows which claims match and which need additional information prior to payment. Data aggregation and near real-time processing provide commercial health plans with financial insights, as well as the ability to manage utilization of prior authorizations and improve outcomes.
Private Insurance
Manage Private Insurance Utilization and Reduce Fraud, Waste and Abuse
Simplify managing prior authorizations and claims submissions:
- Reduces manual reporting
- Allows commercial health plans to manage usage of prior authorizations and improve outcomes
AT A GLANCE
Simplify managing prior authorizations and claims submissions:
Features- Web-based solution integrates with over 100 EHRs and EVV apps
- Supports verification of regulatory compliance and prior authorizations
- Reduces manual reporting
- Allows commercial health plans to manage usage of prior authorizations and improve outcomes
- Allows monitoring of members to ensure compliance for clinical & financial data
- Highlights clinical data capture to provide oversight to change in condition measures
