Authorization and Referral Management

Enable prospective, concurrent, and retrospective referral and authorization management.

VALUE

Leverage smart workflows driven by evidence-based guidelines to simplify utilization management and control costs while ensuring compliance.

Manage referrals to ensure patients are seen by the right providers at the right time.

DIFFERENTIATORS

Automate workflows and rules to authorize services and referral requests.

Inform patients and providers of decisions with regulatory-compliant documentation.

Enable providers to submit authorization requests via a self-service provider portal.

Authorization Management Features

SyntraNet supports end-to-end utilization management

  • Full-service provider portal that can be integrated via SSO
  • Services/referral management
  • Customizable auto-authorization rules
  • Integration with care guidelines for single-button access
  • Automated correspondence, including written translation
  • Compliance tracking
  • Outcome, Cost & Quality metric tracking
  • Care team/delegated provider workload management

Authorization workflow

Authorization and Referral Management example use cases

Example use case Description
Provider Responsiveness Accepts requests via many methods and designed to tailor review process by provider
Automated utilization management rules engine Authorizations can be auto-approved based on pre-defined rules and integration with care guidelines enables evidenced-based decision making with a single click.
Manage grievances and appeals SyntraNet includes a default workflow for G&A that meets regulatory requirements, ensuring timely processing of complaints with worklists, due date reminders, and notifications. The workflow can be configured to meet specific client needs.

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