Utilization Management - Manage Authorizations

Effectively Manage the Authorization Life Cycle

The Utilization Management module supports the authorization life cycle — from request and review to status determination and correspondence with members and providers. GuidingCare UM helps you manage utilization effectively through helpful clinical guidelines and configurable authorization management workflows.

Direct access to clinical guidelines

Track CM and UM Activity in one record

Manage TAT requirements across programs

Streamline authorization and decision workflows

Direct Access to Clinical Guidelines

Extensive integration with MCG and InterQual provides users with direct access to evidence-based clinical guidelines so users can instantly transfer selected criteria to support authorization requests, decisions and appeals.

Manage TAT Requirements Across Programs

Turnaround time (TAT) for review, approval, correspondence and other activities are configurable by auth type and benefit program to help you maintain compliance across all lines of business.

Track CM & UM Activity in One Record

The GuidingCare platform consolidates all member information into a single, comprehensive care record that's shared across all modules and authorized users. CM and UM staff can view current and historical health and encounter details, authorizations, correspondence and more.

Streamline Authorization & Decision Workflows

The Utilization Management module adjusts to your organization's specific needs to support clinically sound workflows for authorizations, reviews and service approvals. Our templates automatically pre-populate data to save time and improve accuracy.