
Real Questions
4
Payors
-
Payors: Auto-adjudication of prior authorization and care pathways
-
Why are you still reading every clinical note (outdated 20th century manual processes)?
-
Why are you still delaying medically necessary care (with denials as a success metric)?
-
Why are you still paying for 3rd party UM (that sometimes “churn” the account)?
-
Why are you still paying for peer-to-peer reviews? (Triggered by “excessive” policy)?
-
Why are you still making employers and employees angry?
-
Why do you still think all authorization elements are recorded in the EMR?
-
Why are you still using metrics of denial of care and not “right-sided” appropriate care?
-
Why are you talking about e-prior authorization that does not contain clinical elements?
-
Why are you not using automated cognitive audit tools for coding & medical necessity?
-
Why are you still having difficulty instituting reasonable site of service criteria?
-
Why are you still using “AI” that is only a one-way conversation (dumb “smart forms”)?
-
Why are you still not using real time cognitive feedback for UM? (Israel Patent 251953)?
-
Why is your clinical network still not singing from the same sheet of music?
