Our 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

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...

2008

  • Created/Launched SMART-UR.  A SaaS application aimed at identifying and automating the approval of low-cost/high-frequency medical requests​

 

2009

  • 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.  

 

2010

  • 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.  ​

2011

  • 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.

2016

  • 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.

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.  For example, one project in the hopper is a user-configurable letter engine that is designed to be integrated with a client's claim system.  The letter engine is capable of automating any kind of routine communication required by the claim organization.