Our History & Experience
Years of Experience Workflow Automation
Medical Requests Processed
Service Transactions Processed
Reduction in Routine Tasks & Decisions
A Remarkable Client Retention Rate
Reduction in Referrals Requiring Manual Bill Validation
Reduction in Medical Requests Requiring Adjuster Review
Reduction in Average Request Processing Time
Integration of Med Auth/UR decisions with Bill Review
Compliance with Regulatory & Business Rules
Our Leadership in Innovation
EHS has led the industry in bringing creative and game-changing applications to the market. Below are just a few of our innovations...
Created/Launched SMART-UR. A SaaS application aimed at identifying and automating the approval of low-cost/high-frequency medical requests
Expanded SMART-UR Application. Introduced SMART-UR as a web-based full-service application for medical pre-auth of UR requests. Created integration capabilities with client claim data.
Launched BaseLine. Smart-UR was our beta that proved the concept for operational performance as well as the readiness of the market to adopt such technologies. The BaseLine Platform was introduced to enhance integrations with multiple disparate systems, and respond to more complex regulatory and business requirements.
Introduction of Express Referral. A significant advance in workflow automation. Deeper integration of BaseLine with client claim systems to identify preferred network vendors to receive authorized medical requests and creation of business rules to transmit such requests to the preferred vendor. Required BaseLine to create interfaces with multiple vendors. Reduced workload on adjusters, eliminated sources of leakage, improved vendor performance, and expedited delivery of approved care.
2012 - 2015
Multiple Workflow Automation Advances. Development efforts focused on a move to the cloud as well as several enhancements aimed at eliminating any non-essential task or decision from the claims & medical professionals' workload. Involved deeper integrations with not only the client's claim system but also various third-party applications accessed by the client in the processing of their claims.
Introduction of Vendor Management & Order Processing. Based on client demand, the Express Referral application concept was expanded to incorporate all third-party vendors and operate as a free-standing application that can be integrated into client claim systems.
2018 - 2019
An Algorithm To Predict a Request's Odds of Certification. The single most advanced triaging resource create to date. It is based on over 800,000 UR determinations and engages multiple demographic and claim variables. The predictive algorithm is 92.5% accurate at predicting requests that will be certified at UR. Client's use the tool to categorize requests for auto-approval, auto-escalation, or requiring a nurse triage. Thus, allowing the skill sets of UR professionals to be better targeted.