Overview

Case Managers employ AIP to (1) assist in validating and reviewing patients' charts to ascertain if documentation adequately supports the current level of care, and (2) generate draft claims documentation for insurance companies. Upon patient admission, Case Managers employ AIP to produce a preliminary utilization review draft, which is then refined by the Case Managers and dispatched to the insurance company with wording optimized for claims acceptance. Throughout the patient's stay, Case Managers continue to leverage AIP for assistance with drafting ongoing utilization review notes. This process not only aids in avoiding insurance denials based on the patient's level of care but also reduces the administrative load on Case Managers.

Features

• Intelligent Chart Review: Case Managers use AIP to simplify the process of going through a patient's chart. Information potentially relevant to the appropriate level of care for a patient (e.g., abnormal lab results, patients' comorbidities, and risk factors based on clinical history) is highlighted for the Case Manager to review.
• Extract Relevant Evidence: AIP enables Case Managers to apply their own evaluative criteria, including care guidelines for specific diagnoses, as well as payer-specific requirements, to craft utilization reviews that are more likely to be approved by insurers.
• Utilization Review Writing: Case Managers use AIP to compose a utilization review note focused on select elements of the patient's chart, which is then verified and forwarded to the insurance company.