History & Experience

14

Years of Experience Workflow Automation

3.1M

Medical Requests Processed

12M

Service Transactions Processed

90%

Reduction in Routine Tasks & Decisions

98%

A Remarkable  Client Retention Rate

70%

Reduction in Referrals Requiring Manual Bill Validation

88%

Reduction in Medical Requests Requiring Adjuster Review

90%

Reduction in Average Request Processing Time

100%

  Integration of Med Auth/UR decisions  with Bill Review 

100%

Compliance with Regulatory & Business Rules

Innovation Leadership

EHS has led the industry in bringing creative and game-changing applications to the market.  A few of our major advances are noted below

  • 2008/9 - Introduced Smart-UR.  The first fully-functioning workflow automation application for medical pre-auth and UR management. Smart-UR was a beta product designed to prove the concept that the convoluted workflows associated with the medical authorization could be streamlined with significant improvements in efficiencies and effectiveness. The test included both a free-standing application as well as a SaaS app capable of integrating within a client's existing software.

  • 2010 - Smart-UR Retired/BaseLine Introduced.  Smart-UR proved the concept not only for operational performance but also for the readiness of the market to adopt such technologies.   The original product was dispatched and the BaseLine Platform was introduced, allowing for greater integration with multiple disparate systems, more complex regulatory and business requirements, as well as a more modern design.  

  • 2011 - Introduced Express Referral.  Application designed as a part of BaseLine to expedite referrals for authorized medical requests to service and medical providers as well as eliminate leakage from clients' ancillary networks.

  • 2013 - Enabled Data Entry by External Parties.  Delivered functionality for clients to securely allow third-party vendors to perform initial data entry; providers were one of the groups piloted.  Thereby removing the process from the claim office and only needing to engage a client's professional team when their specific knowledge/decision is required.

  • 2016 - Introduction of Vendor Management & Order Processing.  Given the success of the Express Referral application, the concept was expanded to incorporate all third-party vendors operating as a stand-alone, yet integrated, product on the BaseLine Platform.  The system creates a single channel for communications between adjusters/vendors, eliminates network leakage, and brings daylight into the vendor's delivery performance.  The system now integrates around a hundred 3rd parties and hundreds of client-driven business rules governing the direction of referrals.

 

  • 2018/19 - An Algorithm To Predict a Request's Odds of Certification. The single most advanced triaging resource since Smart-UR. We reviewed over 800,000 UR determinations and considered multiple demographic and claim variables. The result is a predictive algorithm that is 92.5% accurate at predicting requests that will be certified at UR.  It can serve as a global 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.

And then came COVID... We put a number of exciting projects on hold because of COVID.  We look forward to reengaging development efforts on these in 2022.  Our focus is shifting to issues that go beyond just the medically related topics we've addressed to this point.  For example, one project in the hopper is a user-configurable letter engine capable of automating any kind of communication required by the claim organization.