Emdeon Utilization Alerts

Emdeon Utilization Alerts expedites and improves healthcare encounter notifications, enabling more real-time decision-making and follow-up. Utilization Alerts allows payers to leverage Emdeon's existing electronic connections to receive early and timely alerts when members present for healthcare services, allowing for more meaningful and impactful member outreach, engagement and education.

Leveraging the standard eligibility verification process and existing provider/facility workflows, payers are notified earlier in the healthcare encounter when a member presents for a specific service, such as an Emergency Room Visit, Urgent Care Visit or Inpatient Admission. Timely notifications enable payers to engage members earlier in the healthcare encounter rather than relying on traditional solutions that utilize stale claims data for identification.

Our solution provides notification either at the point of care or shortly thereafter, which allows the payer to start discharge planning earlier, begin utilization reviews much sooner, refer to care management and disease management programs, as well as support a teachable moment by providing meaningful intervention, education and follow-up in a real-time manner. Ultimately, Utilization Alerts can lead to administrative efficiencies, enhanced care coordination, improved quality and decreased costs.

Features

• Early identification and prioritization of healthcare services for utilization and case management notification
• Automated health plan notification when a member presents for healthcare services
• Timely notification to the health plan when Emergency Services and other identified services are utilized enables Utilization or Case Management teams to rapidly intervene
• Eligibility-based notifications can replace other forms of required provider notification to payers
• Encourage care alternatives through earlier member engagement, resulting in higher quality yet lower cost healthcare
• Engage provider networks with early notifications when members present for emergency care

Benefits

• Complement your existing utilization and case management programs
• Lower ongoing emergency service costs through early engagement and diversion of non-urgent services to more appropriate levels of care
• Improve quality and cost through earlier Case Management engagement and referrals to other programs