Solution

Industry Content        

Structured industry content for payers and providers who want to support consistent application of third-party content and policies and improve review workflow.

What’s included in Industry Content

  • Medicare content

    • Medicare policies in structured, interactive Q&A format
    • Quantity and time-frame utilization limits and non-covered indications and services
    • Comprehensive content including nearly 500+ Medicare National and Local Coverage Determinations (NCD/LCDs) formatted into 125+ subsets of medical necessity criteria
    • Links to MAC / policy
    • NCD or LCD/MAC auto selection
    • Frequent content updates every 6 weeks to keep up with rapidly changing LCD/NCDs
  • The ASAM Criteria® Navigator

    • The ASAM Criteria in structured, interactive Q&A format
    • Recommendations for appropriate level of care and services
    • Comprehensive content including all ASAM levels of care and withdrawal management covering all dimensions
    • Interrater Reliability testing for improved consistency and accuracy of criteria use
  • Available modules

    • The ASAM Criteria® (exclusive access)
    • Medicare Behavioral Health
    • Medicare Durable Medical Equipment
    • Medicare Imaging
    • Medicare Molecular Diagnostics and Lab
    • Medicare Pharmacy
    • Medicare Procedures

Structured, interactiveguidance to drive consistent, efficient reviews

Intuitive Q&A format for UM to simplify and speed review workflows

Reduce review times, support review consistency, and streamline the prior authorization process with content from third-party sources that is converted into a structured, interactive tool using our easy-to-use Q&A format for utilization management (UM).

Integrated into a single UM workflow for easy access

Industry standard-of-care and regulated-use guidelines that exist in disparate sources or are cumbersome to navigate are streamlined and incorporated seamlessly into your existing UM workflow. Providing a single source for content helps minimize the need to use and update multiple systems and supports the consistent and efficient application of medical policies.

Medicare Content Navigator to streamline reviews for Medicare patients

Quickly align your decisions with hundreds of Medicare NCDs/LCDs and related policies by relying on structured criteria for medical necessity support, quantity and time-frame utilization limits, and non-covered indications and services.

The ASAM Criteria® Navigator to meet SUD mandates

Streamline and improve the medical review process for substance use disorder patients with The ASAM Criteria converted into a structured, interactive tool focused on the needs of utilization management. Developed in partnership with ASAM, this interactive version of their criteria helps you increase consistency and significantly reduce the time required for SUD patient assessments while aligning with CMS 1115 waiver requirements and state mandates.

Our outcomes

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 The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine

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