Automated Workflows

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Improve Workflow Processes and System Scalability

AveCare's Utilization Review is a fully automated process that allows clinicians and support personnel to efficiently and effectively handle review activity. The integrated design along with user configured features improves workflow processes and system scalability.

The following is a list of some of the Automated Online Processes:

  • Support for initial review intake by support personnel and automatic forwarding to a clinician or a designated queue for review
  • Online referral program for physician/supervisory reviews and tracking of timeframes for regulatory and certification timeframes
  • Automation during the intake process to forward the request to a group queue for automated follow-up when clinical information is not received
  • Online referral tracking to specialists 
  • Notification at the time of the initial request that the patient is currently being managed by a case manager or disease manager, including the name of the manager for forwarding to the appropriate clinician for handling 
  • Online diagnosis triggers for automatic notifications and reporting to insurers/reinsurers for potential large claims 
  • Referrals for potential case management and disease management based on diagnosis triggers 
  • Online CPT and ICD codes with look-up capabilities 
  • Customized letters produced directly from AveCare 
  • Access to the system's physician and facility databases for automatic entry of provider demographics 
  • Automatic conversion from outpatient to inpatient (or vice versa if applicable) 
  • Automated time/date stamping of all reviews and referrals for compliance and quality

Next: Coding and Embedded Criteria