Payers
Unlock Insights.
Grow Revenue.
Reduce Costs.
emtelligent’s medical AI solutions put data in the hands of teams across the organization to deliver new value and efficiency.
Get the complete picture of health
Payer Solutions
Seamlessly configure our solution to improve efficiency and performance in these critical areas:
Key Features
Risk Adjustment
- Eliminate manual chart review
- Close previously unknown care gaps
- Get reimbursement for your full member risk
Medicare STARS & HEDIS
- Access new clinical data to create a full member profile
- Identify new care gaps and drive improved program performance
- Improve the clinical quality of your network through enhanced insights
Prior Authorization
- Eliminate costly and time-consuming manual review
- Access the full patient record to increase accuracy
- Get real-time answers to patient data inquiries
Underwriting
- Improve pricing accuracy with enhanced data
- Tap into the full clinical record to build member profiles
- Increase speed of pricing, quote delivery
Care & Disease Management
- Access new insights from the clinical record
- Identify new members eligible for intervention and support
- Gain a more complete view of member health history
Payment Integrity
- Quickly compare claims to clinical data
- Reduce inaccurate claims to lower costs
- Improve auto-adjudication rates
Risk Analysis & Modeling
- Improve model predictiveness
- Identify and engage high-risk members earlier
- Feed structured output back into the EHRs to enhance clinical workflows
Our work in the industry
Accelerating Prior Authorization
Prior authorization is one of the most time-intensive tasks for payers, requiring staff to review lengthy, complex medical records. By implementing emtelligent’s AI-Assisted Chart Review solution, a leading payer automated case preparation and criteria matching, enabling nurses to complete reviews faster, cut administrative burden, and improve both provider and member experiences.
Full Case Study