AGS Health's Utilization Management (UM) services assist healthcare organizations in delivering appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews. Their program ensures patient care aligns with current medical standards and optimizes resource allocation. Utilizing MCG and InterQual criteria, AGS Health confirms that cases meet established guidelines and determines the appropriate length of stay. They maintain clear communication with payers and internal teams, identify and mitigate potential risks such as overutilization, and analyze medical necessity denials to address root causes.

Dragonfly Utilize is a hospital utilization management software designed to optimize resource use and ensure high-quality patient care. It provides real-time views of clinical data, enabling healthcare teams to focus on cases requiring immediate attention. The platform employs AI-driven analytics, including the Care Level Score to assess medical necessity and predict patient status with up to 94% accuracy. This approach aims to improve operational efficiency, reduce unnecessary audits, and enhance collaboration between providers and payers.

EvidenceCare's AdmissionCare is an EHR-integrated solution designed to streamline the patient admission process by helping physicians at the point of care in determining the appropriate bed status based on clinical and payer criteria. It reduces medical necessity denials, improves revenue capture through more accurate inpatient decisions, and accelerates handoffs between care teams. The tool also helps physicians focus on patient care by minimizing interruptions related to documentation and bed status issues.