• Clear Coverage


Intelligent, automated decision support tools at the point of care

Every health plan is seeking ways to reduce inappropriate administrative and medical costs. Clear Coverage™ helps plans to effectively manage and lower these costs with an intelligent, automated decision support tool at the point of care.

Clear Coverage is a point-of-care utilization management, coverage determination and network compliance platform. It incorporates InterQual® Criteria in a fully automated, interactive workflow to support targeted, shared decision-making between a payor and its network providers. Clear Coverage is offered as a hosted, web-based solution, dramatically reducing implementation, operating, and maintenance costs and shortening time-to-value for the customer.

Advanced authorization: fully automated, intelligent and targeted

Payors know the challenges of authorization processes, including expense ($50-100 per authorization); speed (3 to 4 days or more); lack of consistency; missed cost savings opportunities. Clear Coverage goes beyond basic authorization to address the substantial cost and effort of manual medical appropriateness review.

Clear Coverage's advanced authorization goes further by incorporating InterQual Criteria® to enable fully automated, real-time medical appropriateness review at the point of care. As a result, health plans can focus valuable UM resources on exceptions that truly require their expertise:

  • Enables transparent, immediate access to coverage, medical appropriateness and network rules
  • Drives consistent application of evidence-based medical policy
  • Provides the full spectrum of automated UM: notifications, basic and advanced authorizations
  • Supports real-time, targeted provider interventions

With Clear Coverage, providers and members understand encounter-specific coverage and cost before services are provided. Members can make in/out-of-network choices with full understanding of their financial responsibility. 

Benefits:

  • Lowers administrative costs as much as 40%, enabling UM program expansion to other medical cost areas
  • Automates medical review with InterQual® criteria for guidance - quickly and without manual intervention in most cases
  • Determines lower cost, medically appropriate alternatives 
  • Enforces consistent rules
  • Facilitates gold/red carding based on provider-specific activity within the system
  • Provides a greater ROI than “basic” authorization portal solutions

Do you want to know more about how you can bring auto authorization to your providers? Call us at 800.782.1334 or request more information.