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Optum
Interqual AutoReview
InterQual AutoReview enables medical necessity reviews by extracting and analyzing real-time clinical data from EHRs. Utilizing AI and robotic process automation, it generates InterQual medical reviews upon patient admission or on-demand, embedding EHR data to support transparent and defensible documentation. This automation aims to reduce administrative burdens, enhance review accuracy, and improve efficiency in utilization management processes.
Product Overview
Security and Compliance Certifications: SOC 2 Type 2, HIPAA, ISO 27001
InterQual AutoReview enables medical necessity reviews by extracting and analyzing real-time clinical data from EHRs. Utilizing AI and robotic process automation, it generates InterQual medical reviews upon patient admission or on-demand, embedding EHR data to support transparent and defensible documentation. This automation aims to reduce administrative burdens, enhance review accuracy, and improve efficiency in utilization management processes.
Customers Served
Categories
Company Info
HQ Location
Eden Prairie , MN
Founded
2011
Headcount
5001-10000
Total Funding
Not available
Latest Round
Not available
Latest Round
Not available
Company Socials
AGS Health
AGS Utilization Management
Company Info
Founded: 2011
Customers
Customers Served: Hospital / Health System
Product Overview
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.
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Versalus Health
Corro Clinical Utilization Management
Company Info
Founded: 2016
Headcount: 51-200
Customers
Customers Served: Hospital / Health System
Product Overview
Security and Compliance Certifications: HIPAA
Corro Clinical, formerly Versalus Health, offers a utilization management solution that integrates data analytics with a services-oriented clinical expertise to enhance hospital revenue integrity and compliance. Their approach includes refining internal processes, identifying compliance risks, managing denials and appeals, and providing ongoing education.
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Xsolis
Dragonfly Utilize
Company Info
Founded: 2013
Headcount: 201-500
Customers
Verified Customers: 3
Customers Served: Hospital / Health System
Product Overview
Security and Compliance Certifications: HITRUST CSF, SOC 2 Type 2, HIPAA
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.
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