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Cadalys CareIQ Utilization Management

Evidence-Based Decision Support For Clinical Review Processes

Overview

CareIQ Utilization Management for Health Cloud leverages 3rd party clinical content and evidence-based guidelines to streamline & automate the costly and time consuming review processes that drive up costs and delay getting patients access to care.

See How Cadalys CareIQ Utilization Management Works

Next-generation Clinical Decision Support to Automate: Prior Authorization, Medical Director Review, Concurrent Review, Appeals/Grievances, Complaints & Claims Adjudication
Custom Curation of Medical Coverage Policies to structure and streamline clinical reviews including National Coverage Determinations (NCDs) and Local Coverage Policies (LCDs) to support Medicare and Medicaid determinations
Dramatically increases efficiency of MD and RN tasks, eliminating tedious swivel chair processes with a highly intuitive UI to facilitate clarity and faster, more accurate evaluation of clinical guideline criteria in a single pane of glass

Standardize & Operationalize UM Processes Payers and providers need an alternative to current approaches for utilization management that require lengthy, burdensome steps to review and apply clinical guidelines and coverage policies. There is a critical need to break down silos and consolidate content for more consistent and efficient UM processes. Through a flexible, powerful curated content engine that embeds any third party medical coverage policies and evidence-based guidelines into the Salesforce Health Cloud platform, CareIQ for Utilization Management delivers unified workflows to automate clinical decision support across the payer-provider lifecycle. Our purpose-built solution presents review data in a logical and consumable experience that speeds up interpretation and application of UM criteria so clinicians can focus their attention on serving members and patients. - Eliminate swivel chair processes by consolidating clinical review content in a single pane of glass - Enhance payer-provider collaboration to ensure appropriate, timely care and reduce denials - Reduce cost per transaction and improve turnaround times