In the complex system of U.S. healthcare, care providers grapple with cumbersome but necessary utilization management processes. In fact. 15 to 30 percent of medical spending is now dedicated to administrative tasks rather than clinical where it should be. Zyter|TruCare’s 10.2 Release brings operational efficiency to our health plan’s Utilization Management processes. We are introducing purposeful enhancements to empower healthcare providers to reclaim their time and focus on delivering quality care directly to their patients.
Illustration by Mike Werner
Breaking Down Utilization Management Barriers
Utilization Managers at US Health Plans require intricate compliance-heavy processes to meet standards, such as CMS’s Organization Determinations, Appeals, and Grievances (ODAG) requirements. Manual procedures prone to errors consume valuable time, hindering efficient patient care. TruCare® 10.2 addresses these challenges with enhancements focused on modernizing utilization management workflows.
Key Utilization Management enhancements include:
- Automated Compliance Date Calculation: Appeals Specialists can now rely on precise timelines, contributing to the overall reliability and efficiency of the appeals process. Our advanced algorithms ensure compliance dates are calculated accurately, eliminating the margin of error.
- Enhanced Task Automation: Appeals Specialists can easily navigate diverse scenarios thanks to our configurable Process Engine. Users receive increased efficiency as routine tasks and one-off UM scenarios can be addressed with our enhanced and flexible process tools.
- Simplified Configuration. Business Administrators can effortlessly adapt and realign TruCare workflows as things change to meet evolving authorization and appeals processes.
- Compliant Turnaround Times: Compliance Leaders can configure turnaround times that adapt seamlessly to current standards and evolving regulatory requirements. This heightened flexibility ensures sustained compliance, promoting operational efficiency aligned with industry standards.
- Reduced Manual Errors: UM Teams are empowered with significantly reduced manual workload burdens, resulting in minimized errors and heightened accuracy throughout the appeals process. A more streamlined approach enables them to concentrate on critical aspects of their role, fostering an overall increase in efficiency and effectiveness.
Optimize Your Utilization Management Strategy with Zyter|TruCare
Our TruCare®10.2 Release reflects our firm commitment to our customers. We actively listened to their feedback, understood challenges, and translated insights into practical solutions. Their input has been crucial in shaping a solution that streamlines processes and meets and surpasses expectations.
Zyter|TruCare™ remains dedicated to delivering solutions that address current challenges and anticipate future needs. Our commitment to operational excellence endures as the healthcare landscape evolves, empowering providers and contributing to better patient outcomes.