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Medical Management: Authorizations, Case Management,
Concurrent Review
EnCore Medical Management
enables you to enter and track authorizations, manage a
"case" and perform concurrent review. These
processes are integrated with the core claims system and
will alert claims and customer service personnel if an
authorization or case is on file for a member.
Coding conventions used for authorization and case
management are user-defined and provide the flexibility
to tailor the system to your individual needs and policies,
such as:
EnCore Advantages:
Authorizations with automated
claim/authorization match
Actual IP days or OP occurrences
tracking
Maximum approved dollar amounts by
procedure or type of service
Case Management that tracks episodes
of illness
Concurrent review
The ability to actively manage
medical costs
Support for all types of care
provided during a treatment episode
The ability to analyze the
effectiveness of cost containment
measures
A flexible system for tracking large
case management opportunities
A method of measuring both units and
dollars saved by the certification
process
A total Managed Care solution
Ability to attach specific treatment
plans
EnCore Incorporates:
Multi-level help resources
Unlimited notepad capabilities
Length of stay table integration
Parameter based system design
User defined coding conventions
Ad Hoc reporting
EnCore Medical
Management solutions can bring new levels of efficiency and
productivity to your case management team thereby enabling them to
deliver superior customer service.
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EnCore System Professionals, Inc. 14701 St. Mary's Lane Suite 150 Houston, TX 77079 Voice: 877-536-2673 Fax: 281-368-7828
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