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Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
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Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
Awards
Differentiators
Keywords
Media
Company details
eviCore intelliPath
eviCore intelliPath

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Categories

Solutions

Description

Product Description:
eviCore intelliPath® is eviCore’s electronic prior authorization solution housing a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions, case validation, and simplified clinical surveys. eviCore intelliPath® is deployed by provider organizations to automate and simplify submitting and tracking requests for prior authorization. eviCore intelliPath® streamlines operations within a single easy-to-use application that integrates with major electronic health record (EHR) vendors. Provider costs are reduced and decisions are communicated in real time, reducing delays.
About EviCore by Evernorth:

eviCore healthcare offers proven, diversified medical benefit management solutions that help clients reduce costs while increasing quality of care for their members. The company provides these solutions to managed care organizations and risk-bearing provider organizations serving commercial, Medicare and Medicaid populations. Powered by a team of specialized medical professional resources, extensive evidence-based guidelines and advanced technologies, the company supports clients by ensuring the right evidence-based care is delivered at the right time to the right patient at the right site of care.

Product Description:

This solution can automate the process of checking requests under review as well as continued status changes and updates. Supports many portals such as Evicore, Magellan, UHC and others. The solution includes business rules, exception handling and daily reporting functionality with customizable dashboard views. It is can be supported by CampTek as an ongoing managed service.

About CampTek Software:

CampTek Software is a Full-Life-Cycle Intelligent Automation SaaS Provider with proven results implementing and supporting automation solutions through our successful methodology. Our unique hosted model offers many powerful advantages including a shorter time to market, 24/7 support and overall lower cost of entry. Our approach is simple and repeatable.

CampTek will be with you on every step of your RPA & AI Journey!

Compatibility level

Select which hospital or health system you work at and see a personalized compatibility level.

Clients

Select which hospital or health system you work at and see the client list

Use Cases

Description:
  • Lower costs for healthcare-delivery organizations
  • Reduced frustration and more transparency for patients and clinicians
  • Better network relationships for health plans
Pediatric use cases:

None provided

Users:

Patients, Providers, Payers

Description:

Industries: Healthcare, RCM

Provider Systems: Epic

Payer Portals: eviCore, United Healthcare, Magellan

Challenge

A large healthcare provider needed to ramp up their automation strategy to offset labor instability and attrition. Currently the staff manually have to go out to payer portals, submit requests and check statuses of Prior Authorizations, sometimes multiple times. Through Task Mining AI (Artificial Intelligence) analysis, it was determined that staff were spending about 30 – 40% of their time submitting requests and checking the status for 19,000 prior authorizations per month.

Prior Authorization Requests: 3 bots processing prior authorization requests in 3 separate portals (EviCore, Magellan and UHC).

  • EviCore: 923 transactions per month
  • Magellan: 595 transactions per month
  • UHC: 7,063 transactions per month

Prior Authorization Statusing: 3 bots processing prior authorization statuses in 3 separate portals (EviCore, Magellan and UHC).

  • EviCore: 5,536 transactions per month
  • Magellan: 3,572 transactions per month
  • UHC: 986 transactions per month

 

Solution:

RPA bots are a much more accurate and effective solution to verify the status of patient health authorizations, RPA bots can repeatedly check requests under review for status changes and updates.

CampTek Software was engaged because of its healthcare and Epic experience. Through task mining, AI models were created, and results were reported back to the customer with enormous success. The next phase of design and build all occurred in a brief time. The bot now in production includes business rules, exception handling and daily reporting functionality. It is also supported by CampTek as an ongoing managed service solution for the provider.

The Bot is now saving 2,696 FTE (full-time employees) hours per month or 32,352 hours (about 3 and a half years) per year. The FTE capacity gain is 17 FTEs (full-time employees), and the ROI (Return on Investment) is $1,085,000 per year.

Pediatric use cases:

None provided

Users:

Any healthcare provider

EHR Integrations

Integrations:

None provided

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

Epic

Hardware Compatibility:

None provided

Integrations:

Acute care EMR, Ambulatory EMR, Ancillary EMR, ERP system, Patient portal, Pop health platform, Home health, Behavioral health, Community based organizations, ADT, Access +/or revenue cycle, Credentialing, Website / public online sources, Other

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

Epic, Cerner, Meditech, Allscripts, NextGen, athena, GE, eClinicalWorks, McKesson, Other, Allscripts/Eclipsys, Athenahealth, Azalea Health/Prognosis, CPSI, Evident, Healthland, MEDHOST, MedWorx, QuadraMed, Self-developed, Would prefer not to disclose, Point Click Care

Hardware Compatibility:

None provided

Client Types

None provided
None provided

Awards

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Differentiators

Differentiators vs EHR Functionality:

eviCore intelliPath® is eviCore’s electronic prior authorization solution housing a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions, case validation, and simplified clinical surveys.

eviCore intelliPath® is deployed by provider organizations to automate and simplify submitting and tracking requests for prior authorization. eviCore intelliPath® streamlines operations within a single easy-to-use application that integrates with major electronic health record (EHR) vendors. Provider costs are reduced and decisions are communicated in real time, reducing delays.

Differentiators vs Competitors:

Administrative Cost Savings

eviCore’s medical benefits management solutions are proven to reduce unnecessary–and potentially harmful–tests and procedures. But securing prior authorization can impose a high burden on provider organizations; for example, dedicated administrative staff are hired to request and track cases, and clinicians typically must allocate time to provide details on the patient’s medical diagnosis.

In place of implementing an abundance of tools, multiple health plan portals, and time-consuming manual interactions, eviCore intelliPath® simplifies and streamlines prior authorization operations with a single, integrated application. eviCore intelliPath® leverages the substantial investment in EMRs on the part of provider networks. It automatically incorporates case details from the patient’s chart and fits seamlessly into clinical and revenue cycle workflows.

Clinical Efficiency

Further, eviCore intelliPath® integrates with eviCore’s utilization management system (and those of other UM providers). This speeds communication of critical information (e.g., automated approval, no prior authorization required, or additional clinical information is needed for a decision to be made). With the approval or denial in hand, patients can be scheduled or alternative tests or procedures ordered in a timely fashion.

Benefits for Patients, Providers, and Health Plans

  • Lower costs for healthcare-delivery organizations
  • Reduced frustration and more transparency for patients and clinicians
  • Better network relationships for health plans
Differentiators vs EHR Functionality:

We offer Intelligent Automation as a Managed Service and have successfully built automations for every major EHR.

Differentiators vs Competitors:

We not only focus on development but also full support of bots once they are in production. Each bot has its own custom dashboard view so that our customers are continuously informed of its daily trransaction metrics and KPIs.

Keywords

Images

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Videos

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Prior Authorization Request: EviCore

Downloads

https://www.evicore.com/insights/hypofractionation-radiation-therapy-is-valuable-for-treating-breast-and-prostate-cancer
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Company Details

Founded in 1994

Founded in 2018

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