Utilization management solutions
Streamlining pre-authorizations to reduce costs
MedCert is AllMed's medical review solution for health plans seeking a partner to take on some or all of their utilization management operations. With MedCert, health plans and medical management organizations can easily offload physician review and utilization management to AllMed, increasing their capacity and flexibility, while containing costs.
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. This can lead to burnout and turnover and directly impact both quality and cost.
That's why payers are increasingly looking to optimize the work of their Medical Directors by focusing them on strategic initiatives, such as medical policy and plan language development, quality program oversight, and other higher value-added tasks. By offloading physician pre-authorization reviews to AllMed, you can focus your scarce Medical Director resources on other programs and initiatives.
- Nurse review/prepartion of incoming UM requests, and routing of appropriate cases to AllMed physicans for review
- Physician review of cases that don't meet medical policy, plan language or standard of care criteria
- Communication of determinations to members (coming soon).
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.
Payers use medcert for:
- Offloading routine UM physican review operations
- Coverage for Medical Director vacations and vacancies
- Handling seasonal medical review caseloads and volume fluctuations
Want to learn more about how MedCert can help streamline your operations? Download the brochure.
Want to learn more about the changing role of Medical Directors in payer organizations? Download this free white paper.