UTILIZATION MANAGEMENT
Streamline referrals and authorizations
Ensure the appropriate utilization of services
Manage prospective, concurrent and retrospective referrals and authorizations using configurable workflows and rules to authorize services and referrals.
Access regulatory-compliant documentation to inform members and providers of medical management decisions.
Integrate medical management, quality management, and care management so these areas of operation are synchronized.
Track members in real-time as they move through the service delivery system.
Automate pre-approvals for high-performing providers while providers with higher denial rates can be reviewed more intensely.
SyntraNet supports end-to-end utilization management
Manage referrals to ensure members are seen by the right providers at the right time.
Automate workflows and rules to authorize services and referral requests.
Inform members and providers of decisions with regulatory-compliant documentation.
Enable providers to submit authorization requests via an SSO integrated self-service provider portal.