Payers
As a payer, your biggest enemy is the unknown
Understand member risk like never before. Use new clinical insights to improve performance across your organization, from underwriting and risk adjustment to prior authorization and utilization management. That’s emtelligent.
Get the complete picture of health
Risk Adjustments
- Unlock hidden risks in member medical records that are undetectable with traditional claims data
- Close previously unknown care gaps to increase risk adjustment performance
- Improve efficiency by significantly reducing the need for manual chart review
Medicare STARS & HEDIS
- Leverage clinical notes to gain a full picture of member history and needs
- Drive improved STARS and HEDIS program performance by leveraging the full clinical record to identify care gaps and opportunities
- Uncover new insights to improve clinical quality and augment data from other provider programs
Prior Authorization
- Rapidly review a patient’s full medical record when seeking supporting evidence for an approval or denial
- Eliminate costly and time consuming manual review efforts with reliable and auditable chart summaries, focusing your clinical teams on higher value activities
- With the emtelliPro+ assistant, import policy details and supporting business-rules to make approval determinations and automate letter development
Underwriting
- Leverage the full clinical record in addition to historical claims data to pinpoint risk in both existing and prospective member populations
- Use new risk data to more accurately price products across your portfolio
Care & Disease Management
- Pinpoint details about your members’ health history otherwise unknown from claims data
- Increase eligibility for all of your clinical intervention programs, improving your ability to impact outcomes and costs
- Gain insight into valuable member background information and contributing factors like social determinants of health
Payment Integrity
- Connect data in the clinical notes to claims details to reduce claim errors and ensure accuracy
- Improve auto-adjudication rates and payment accuracy while reducing fraud, waste, and abuse and subrogation impacts
Member Engagement
- Leverage insights from patient records to improve click-through rates on member reminders and next best action opportunities
- Refine personalization strategies and tailor recommendations based on the experiences and care needs of individual members
80%
of clinical data is unstructured and inaccessible outside of a costly and time consuming manual review process
Payers are faced with terabytes of clinical data in a variety of formats, across multiple silos and business units.
Our payer customers are actively using emtelliPro and emtelliPro+ to power clinical transformations that organize their disparate data and surface the insights needed to fuel their business.
How it Works
- Identifying hidden population risk
- Discovering pricing and cost savings opportunities
- Improving care team productivity
- Powering custom app development
- Advancing analytic needs