Prior authorization reduces fraud, waste and abuse

Utilization management

Utilization management from Netsmart automates prior authorizations and allows state agencies and managed care organizations (MCOs) to monitor delivery of Medicare and Medicaid services.

The web-based solution integrates with electronic visit verification (EVV) applications and electronic health records (EHRs) to give payers real-time insights into the status of prior authorizations. It aggregates provider data into a dashboard that reduces manual reporting and simplifies analysis of service delivery. As a result, payers can reduce costs by optimizing prior authorizations, improving authorizations management and addressing any waste, fraud or abuse.



A web-based solution for state agencies and MCOs that automates prior authorizations and integrates with EHRs and EVV applications to simplify analysis of provider services

  • Integrates with provider EHRs and EVV applications to support monitoring of service delivery
  • Aggregates provider data into an easy-to-use dashboard
  • Reduces manual reporting and authorization steps
  • Offers real-time insights into status of prior authorizations
  • Simplifies analysis of service delivery
  • Supports optimization of prior authorizations based on outcomes
  • Helps reduce costs by highlighting suspected waste, fraud and abuse

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