OUR SOLUTIONS
The GuidingCare® platform has an embedded best-in-class rules engine that streamlines operations by automating business processes and workflows. The rules engine is highly configurable, so you can easily create or modify rules as business requirements change. The types of rules that users can define include:
The rules engine identifies gaps in care based on clinical data, member events and pre-determined business rules, allowing you to better manage outcomes with targeted interventions for the members who need them most.
Improve efficiency in workflows by applying consistent business rules across your operations. Enhance clinical workflows to support value-based care by auto-generating activities related to complex care coordination, including decision-making, care programs and staff assignments.
The rules engine is integrated with our analytics tool, enabling predictive modeling with risk identification, scoring and stratification that can be incorporated into operational rules.
The rules engine is highly configurable and allows users to create or modify rules as business requirements change, including for eligibility routing, operational and clinical alerts, and authorization approvals.
Stay Ahead of the Curve
Sign up for our industry-leading newsletter.
Privacy Statement / Compliance