Automate the Prior-Authorization Process

The prior-authorization process is intended to help you manage costs, while ensuring that your members receive appropriate, medically necessary care. Unfortunately it is often inefficient and costly, and can lead to delays in care, potentially creating risk for patients. With InterQual Connect seamlessly integrated into GuidingCare, you can easily automate all authorization requests–even those requiring a medical review–right within your existing workflow.

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2. Automate the prior-authorization process within GuidingCare® with InterQual Connect™
3. PROPRIETARY & CONFIDENTIAL 3 InterQual® decision support solutions • Payer/provider connectivity • Automated authorization • MDx policy management • Exception-based UM Technology Integration, automation and connectivity • Evidence-based decision support for UM & CM • Addressing comorbidity (medical & behavioral) • Unique test identification - DEX Z-Code™ • Shared clinical intelligence Content Clinical appropriateness and complex care management
4. PROPRIETARY & CONFIDENTIAL 4 InterQual® decision support solutions
5. PROPRIETARY & CONFIDENTIAL 5 InterQual Connect – one solution, two capabilities Working together to enable an automated authorization process Authorization Connectivity – authorization submission and automated decision response InterQual Content – InterQual® Medical Review Service at point of decision for provider and payer InterQual Connect delivers two capabilities within existing workflows:
6. PROPRIETARY & CONFIDENTIAL 6 Seamless access to InterQual® content
7. PROPRIETARY & CONFIDENTIAL 7 Reduce IT burden and increase transparency with cloud-based content and software Simple to Deploy Simple to Update Content and Review Sharing Multi-Browser Support
8. PROPRIETARY & CONFIDENTIAL 8 InterQual Connect – one solution, two capabilities Working together to enable an automated authorization process Authorization Connectivity – authorization submission and automated decision response InterQual Content – InterQual® Medical Review Service at point of decision for provider and payer InterQual Connect delivers two capabilities within existing workflows:
9. PROPRIETARY & CONFIDENTIAL 9 The current prior authorization process – manual and inefficient
10. PROPRIETARY & CONFIDENTIAL 10 Your current workflow offers limited automation
11. PROPRIETARY & CONFIDENTIAL 11 Transforming UM from reactive to proactive and collaborative Integration Align payers and providers with common evidence- based criteria, integrated into both workflows Automation Reduce inefficiency by automating routine medical reviews, authorization requests and determinations Collaboration Enable payers and providers to collaborate on complex cases and manage by exception
12. PROPRIETARY & CONFIDENTIAL 12 Collaboration benefits both payers and providers
13. PROPRIETARY & CONFIDENTIAL 13 InterQual Connect meet providers where they are
14. PROPRIETARY & CONFIDENTIAL 14 Content and connectivity through a provider portal InterQual Connect-enabled portals allow provider to submit requests to payer electronically and get an automated response
15. PROPRIETARY & CONFIDENTIAL 15 Content and connectivity through InterQual Review Manager InterQual Review Manager includes review transmission functionality to send authorization request and receive an automated decision response
16. PROPRIETARY & CONFIDENTIAL 16 Content and connectivity fully integrated into existing workflows Partners that fully integrate InterQual Connect can send authorization request and receive an automated decision response
17. PROPRIETARY & CONFIDENTIAL 17 InterQual Connect complements existing capabilities 1 Internal analysis based on data from: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Emergency Department Sample (NIS), 2011, the CDC/NCHS, National Hospital Ambulatory Medical Care Survey and current customers • Provider UI • Upfront payer rules • Auto auth notification • Provider adoption • Payer UI and workflow • UM payer rules • Authorization determination • Viewing provider reviews • Automated InterQual medical review • Secure authorization connectivity Provider Portal UM/CM System InterQual Connect
18. PROPRIETARY & CONFIDENTIAL 18 • Reduces administrative costs by avoiding manual authorizations & redundant medical reviews • Leverages the InterQual® hospital footprint – 3,200+ • Seamlessly integrated into the existing workflows of certified McKesson Alliance Partners • Uses existing IT infrastructure • Provides fast, secure connectivity • Improves payer/provider relations and collaboration InterQual Connect helps realize the potential of UM
19. PROPRIETARY & CONFIDENTIAL 19 InterQual hospital presence Percentage of InterQual Admissions Current as of Oct 2017 Source: Hospitals licensing InterQual Acute Criteria - Internal Analysis and 2017 AHA Database
20. PROPRIETARY & CONFIDENTIAL 20 End-to-end authorization ecosystem with InterQual AutoReview and InterQual Connect
21. Questions?