Payers, TPAs, MCOs and Provider groups can quickly deploy ProviderBASE at the ‘front-end’ of ordering, clinical review, pre-certification and prior authorization, care coordination and cost containment programs to instantly reduce program expense, elevate throughput and performance, and deliver next-level returns.
ProviderBASE℠ delivers “game changing” solutions at the critical time– and point-of-order:
1.) Highly automated Order capture, filtering and direction
2.) Streamlined Order + Clinical Review + Pre-Auth + Network/PPO + Referral + Claims + Report processes – for all stakeholders.
3.) The 3 primary cost containment approaches are elevated:
- Medical Necessity determination (‘Utilization Review’) – Clinical Decision Support (CDS) delivers a ‘virtual review nurse’ with the added value of transparent and educative guidelines, and real-time, self-service ‘appropriateness’ evaluation
- Prior Authorization – assigns status & codes, notifies parties; link IT & claims
- Provider Networks – access contracted Providers/PPOs, Suppliers and Vendors; capture discounted rates; align Authorization codes with re-priced claims