MedCert: Streamlining Pre-authorizations to Reduce Costs

MedCert

MedCert is AllMed's first-level pre-authorization medical review solution for health plans looking for support for their utilization management operations. With MedCert, health plans and medical management organizations can easily outsource the physician review portion of their pre-authorization processes, resulting in reduced costs.

MedCert is designed to:

  • Provide physician review of suggested denials from utilization review and case management
  • Cover for Medical Director vacation and free up your Medical Director to work on higher value-added functions
  • Handle changing medical review caseloads and volume fluctuations
  • Review coverage and experimental and investigational procedures and treatments to determine whether clinical criteria has been met

A core function of Medical Directors is medical case review in which they must use their clinical experience to make determinations regarding medical necessity, coverage, quality of care, and continuation of inpatient care. It is not uncommon for Medical Directors to review 50 or more cases per day, and the volume of reviews to be performed on top of other duties can be overwhelming.

Healthcare payer organizations are increasingly looking to optimize the work of their Medical Directors by focusing them on strategic initiatives. offloading physician pre-authorization reviews to an IRO allows Medical Directors to focus on higher-level, value-added work that is more strategic in nature. Learn more about the changing role of Medical Directors in this free white paper.

Each MedCert review determination is a simple "certify" or "non-certify" determination with an easy-to-read, abbreviated rationale. MedCert is deployed through PeerPoint®, AllMed's state-of-the art medical review portal. This allows you to send, track, and receive cases electronically while meeting the highest information security standards.
 
Want to learn more about how MedCert can help streamline your operations? Download the brochure.

 

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