Allscripts Utilization Management
Allscripts 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