Eligibility And Authorization Management
Monitoring Patient Eligibility
Monitoring patient eligibility to healthcare services based on respective coverage is made with absolute ease with the rules and conditions duly and aptly defined within the system with the flexibility and functionality provided by the rules engine.
Alerts are duly triggered when services ordered are not covered. This automatically generates approval requests or redirects the process to a predefined workflow for further action as appropriate.
Preapprovals and related requests are predefined and can be executed based on predefined workflow processes and documentation flows. These can be supported in a fully electronic environment depending on the support and integration enablement of the payor environment.