Tackle the Hardest Part of UM – the Medical Necessity Review
Prior Authorization (PA) and Utilization Management (UM) practices are a key driver of member retention and satisfaction and is a significant opportunity to differentiate your plan in the market. As you know, complex medical necessity reviews can be time consuming and an expensive process for your nurses and physicians.
At Stanson Health, we are focused on tackling the hardest part—the complex medical necessity reviews. We can help adopt a clinically-focused artificial intelligence (AI) solution in a way that dramatically improves your UM processes and automates your PA, all while gaining the trust of your clinicians and utilization management team.
It’s time to demand instant approval and proof of every decision. Plus, get your members to care faster. Ask us how.
Did you know?
Successful automation can help enhance patient outcomes, reduce physician burden and promote cost improvement.
Cost per Case
Estimated up to $26 per initial case reviewer.1
In 2017, administrative costs totaled $274.5 billion, representing 9.6 percent of total expenditures by insurers and other third-party payers.2
Reduce Per Member Per Month (PMPM):
To as little as 10 cents and eliminate the administrative waste.
Real-time Medical Necessity Determination
Annual Spend ReductionHelp reduce administrative expenses and your PMPM to as little as $0.10.
Smart, Innovative AIUse AI, NLP and ML for fact extraction and rule-based adjudication that can be approved with provenance or proof of why the AI approved the request.
Instant ApprovalValidate a patient’s eligibility and clinical necessity instantly without delaying care.
Show Your Work ApproachThe AI will show its work or provide proof and a transparent decision trail for auditing purposes that is both clinically and legally defensible.
How does Automated Medical Necessity Evaluation work?
- Embedded in payer UM workflow.
- Connects to charts and pulls data in real time.
- Policies automated on configurable platform.
- Medical necessity evaluation is completed.
- Responds with evaluation details.
- Ability to link to evaluation via UM platform.
Learn more about how AI can help you with automated prior authorizations.
There’s no good reason to continue doing things the old way.
Automated Electronic Prior Authorization
For Patients, Providers and Payers
Smart, Fast, Efficient:
Introducing Seamless Patient Care