Utilization Management Solution
MedHOK’s Utilization Management component comes out-of-the-box with Medicare-compliant fields and drop downs to ensure CMS compliance, and is easily configured for other lines of business. The component includes multiple intake channels, auto-population of eligibility data, and structured workflows, tasks, and work queues triggered by business rules to ensure consistent applications of rules, requirements, and medical necessity standards. MedHOK is fully integrated with both MCG and InterQual clinical criteria, and can accept business clinical criteria.
Customers use the solution to:
- Simplify the review process for members and providers resulting from a medical prior authorization
- Create custom auto authorization rules
- Send correspondence and effectuate approvals in the claim systems
- Provide a central location of medical documentation for plan review to make efficient clinical determination on prior authorization
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See How the Industry’s Biggest Health Plans Use MedHOK’s Utilization Management Solution
Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to conduct or schedule your custom demo.