Automate Authorization and Coverage Decisions in Real Time

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The burden of prior authorizations can lead to delayed or inappropriate care and create avoidable cost. Clear Coverage™ is a cloud-based application and platform that helps payers and providers collaborate on coverage decisions in real time and automate authorization.

Clear Coverage incorporates InterQual® Criteria and a health plan’s custom criteria and business rules into a fully automated, interactive workflow to help streamline medical review, benefit and eligibility verification, and network steerage. It enables provider transparency and improves collaboration between payers and providers. By making clinical and coverage rules transparent to providers in real time, medical management staff is then free to review only the minority of cases that truly require their expertise.

Clear Coverage helps:

  • Reduce administrative costs and provider hassles with authorization requests
  • Achieve auto-authorization rates up to 50% or greater
  • Drive in-network referrals
  • Streamline benefit/eligibility verification
  • Improve payer/provider collaboration

Expert, dedicated support

Our dedicated client services team of clinical and technical experts provides implementation, education and consulting services to help you make the most your investment in Clear Coverage.

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