Solution Areas

Disease Management Services
This line of services incorporate telephonic and community outreach, member/beneficiary marketing fulfillment, remote monitoring, physician communications, and data warehousing and exchange to better manage high-cost, high-prevalence diseases.

InterQual Decision Support
This line of InterQual® products provides in-depth, evidence-based clinical criteria and guidelines to foster appropriate and consistent care management decisions. InterQual products are used by healthcare payors, hospitals, behavioral health organizations, and international organizations.

Predictive Modeling
This line of products and services helps payors identify members at risk of developing significant future health issues, in time to proactively intervene.

Professional Certification
This certification program helps healthcare professionals make informed, proactive decisions that result in effective care management programs and strategies, improved quality and reduced costs.

Care Management Workflow Software
This line of products provides a member-centric solution that helps payors decide where to focus their resources, better coordinate care through workflow automation and effective communication, integrate data at key points in the workflow, and base their interventions on evidence-based standards of care.

Nurse Advice Services
This line of services helps payors control costs by providing members/beneficiaries with the best healthcare information possible, helping them choose the proper type of care.

Business Intelligence and Reporting
This line of products helps payors leverage their data to quickly and accurately gain insights into key trends, behaviors and events surrounding physician quality and efficiency, network management, benefit design, regulatory and accreditation reporting, and other issues.

Claims Management
This line of products and services helps payors automate the claims management process, discover billing errors that could lead to overpayment and manage their physician contracts, as well as meet regulatory claims disclosure requirements.