Utilization Management is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis. This process is run by — or on behalf of — purchasers of medical services (i.e., insurance providers) rather than doctors.

HOM understands that members and providers require a solution that solves the time crunchand works seamlessly with their existing system to process requests on time.Our Utilization Management modules can easily integrate with your organization’smanagement system and solve the issues in no time.

Our software is streamlined to take only 2 minutes to view an authorization request in the portal.

With the software’s real-time updates and notifications and flexible architecture to meet specific requirements, HOM offers a user-friendly interface with a reduced turnaround time. All these features provide benefits to:

  • Patients: Get lower costs, more effective treatments, and fewer claim denials.
  • Healthcare Providers: Get fewer claim denials, lower costs, more effective treatments, better data, and better resource deployment.
  • Insurers: Get lower costs, better data, and the efficient evaluation of new treatment and protocols.

Our Tech

Our technology enables seamless operations and improves procedural efficiency reducing processing time by up to 50% and resulting in higher satisfaction.

A robust system to collect, track and maintain data through the latest technology and infrastructure.

All verification and legitimization processes comply with NCQA, URAC, and JCAHO standards.

Highest productivity and quality standards with competitive pricing.

Secure storage of all documents on the client’s server, less chance of a breach.

More acquainted with payor requirements for the credentialing.

Our Edge

01

Enterprise Platform with an intuitive user interface where you get three levels of evidence-based assessment for disease management:

  • Prospective (before the service provided)
  • Concurrent (during the service provided)
  • Retrospective (after the service provided)
02

Compact, efficient and comprehensive workflows with embedded quality checks.

03

Optimized EDI (278 transactions) capability.

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