Allscripts Utilization Management

Allscripts Utilization Management (UM) streamlines the utilization management process by electronically capturing key patient data and providing guidance for obtaining the reviews and approvals necessary to secure authorization and payment of care with the payor. Allscripts UM creates an efficient and effective denial management program to track claim denials and improve an organization's success rate for appeals.

Allscripts UM alerts you when the next review is due, enabling you to fax the requisite information directly through the system to your payor contact. Allscripts UM enables the hospital's business office and utilization management department to work together to identify and track claim denials and to manage the appeal process. Allscripts UM also tracks readmissions, avoidable days, and adverse events.
Offering a comprehensive set of features and benefits, Allscripts UM facilitates the utilization management process.

• Provides a real-time hospital HL7 interface that captures all incoming inpatient, outpatient, and ER encounters. You now have access to the timely, updated encounter details necessary for quickly implementing the utilization review process.
• Automates the reassignment of patients to various utilization managers as patients move throughout the facility.
• Assigns patients to care coordinators based on customizable rules, such as unit, payor, or physician. This eliminates the need for manual, paper-intensive systems, while enabling you to use multiple parameters for patient assignments.
• Flags a readmit for follow-up and monitors the reasons for readmission. This capability provides statistical analyses of readmit data for trends and also benchmarks outcomes for increased efficiency.
• Alerts utilization managers to conduct utilization reviews and to include essential payor and authorization information. The automated alerts facilitate timely reviews of payor status to avoid delays or loss of reimbursable expenses.
• Integrates with McKesson Health Solutions CareEnhanceTM Review Manager Enterprise in order to automate the InterQual® Criteria during the review process
• Faxes clinical utilization documentation directly to the payor. You can now focus on clinical, patient-centric activities, rather than on time-consuming clerical tasks.
• Enables patient-specific communication between the hospital's utilization management department and business office to track and recover denials. The resulting partnership helps hospitals recover denied days and associated payments. The enhanced communication between the two departments also ensures the smooth flow of information relating to continued stay denials and claims denials.
• Tracks and monitors outcomes and variances, including readmits, adverse events, avoidable days, and variances from length of stay. You can generate statistical reports for both real-time and retrospective analysis of critical metrics. You now have the information you need to quickly identify and modify parts of the care management process to more closely reflect "best practices."
• Provides fields for documenting intensity of service, severity of illness, and discharge screening. The ability to review and evaluate patients' clinical care according to established criteria enables you to meet the compliance requirements of external review agencies.
• Interfaces the discharge plan into your EMR.
• Provides extensive reporting capabilities, including tracking and reporting the authorization and denial management process by payor. Allscripts UM includes a standard set of reports and charts and also works with you to create customized reports for your organization.
• Integrates with Milliman® Care Guidelines®, a provider of evidence-based clinical guidelines that improve safety and quality of patient care.
• Receives laboratory results, medications, transcribed notes, history and physicals, and radiology results from clinical interfaces for inclusion directly into a referral
• Tracks the progress of appeals through organizationally defined appeal levels and collects appeal due dates, response dates and notes