GuidingCare™ Utilization Management

The GuidingCare™ Utilization Management (UM) platform 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 strong clinical guidelines and authorization management workflows.

 

Streamline Authorization and Decision Workflows

GuidingCare UM adjusts to your organization's benefit structures and claims systems to support clinically-sound workflows for prior authorizations, concurrent review and service approvals. Configurable auth entry, clinical review and correspondence templates pre-populate data, saving you time and improving accuracy.

 

Track CM and UM Activity in One Record

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

 

Manage TAT Requirements Across All 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.

 

Direct Access to Clinical Guidelines

Extensive integration with MCG and InterQual (Altruista Health is a McKesson Alliance Partner) provides GuidingCare UM users with direct access to evidence-based clinical guidelines. By providing access directly within the application, users can instantly transfer selected criteria to support authorization requests, decisions and appeals.

Learn how GuidingCare™ UM can save you time and help maintain regulatory adherence - every auth, every decision, every day.