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.

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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