Improve Utilization Management with Automation Tools

The healthcare industry is filled with a countless number of clinical and administrative processes that help keep it working. These processes are the backbone of organizations and facilities that work around the healthcare environment. That’s why data processing technologies and automation tools are slowly taking over the industry.  According to an article by the World Economic Forum (WEF), in the year 2022, the majority of organizations will be processing and storing 62 percent of their business data via computers. So if your organization wants to stay competitive within the next few years, you better start incorporating more computer processes in your workflow. With that said, it’s safe to say that if you want to improve your utilization management workflow, you need to start automating your daily processes.


Why Improve Utilization Management?


A URAC article  notes that utilization management deals with heavily evaluating the medical needs and the utilization of healthcare services. This includes the medical procedures and facilities that are under the provision of health benefit plans. The utilization management workflow revolves around improving the quality of patient outcomes as well as ensuring the efficiency of the medical expenses. As a result, this type of workflow requires a lot of data review, analytics, and reports. Additionally, processes like these usually require a lot of paperwork and manpower.


To improve utilization management and get the most effective outcomes, you’ll need to start upgrading your system. With today’s dataflow and industry requirements, processing paperwork just won’t cut it. This means that you need to look for management software that has built-in utilization management tools. When you have the right software, you can easily transact data electronically, which means that you have fewer paper trails and faster data transfer. Advanced software also allows you to improve processing turnaround time through automation features. Additionally, processing data electronically means that you get more accurate results and generate reports at a faster rate. This is all possible when you have integrated software that has all the tools that you need.


Benefits of Having Utilization Management Tools

Today, you won’t find it hard to find different types of software that cater to the operational needs of organizations like IPAs, MSOs, HMOs, and healthcare payer organizations. And with the growing number of options, you’ll need to choose a software that has all the tools you need. To improve utilization management processes, you need a system that has a wide array of features like electronic data interchange (EDI), automation, and data analytics. Having a system that has more tools will generally make your operations smoother. These days, integrated software like QuickCap 7 (QC7) tools can help you with most, if not all, of your business needs. This is because UM software is designed to handle a wide array of data processes and functionalities that healthcare organizations need.


When you have a reliable system, you can easily share data through EDI files which is faster and more accurate than sending paper documents. Also, having electronic files means that your system can also process these files faster with more accurate results. In fact, if you have automation features like QuickCap, you can reduce your manual workload simply by configuring your system to process data automatically. Finally, having the right data analytics features allows you to effectively evaluate all the data that goes through your system. As a result, you get more detailed reports for your evaluations, audits, and everything else.


QuickCap’s Utilization Management Features

How can a software like QuickCap improve utilization management? QuickCap has a fully integrated system which means that it has a wide array of tools and features to meet your utilization management needs so you can reduce costs, increase productivity, and improve patient outcomes.


With QuickCap (QC7) tools, you can experience the following benefits:


  • Access case management features to improve the quality of services at the right costs.
  • Analyze cases with extensive search and audit features to effectively address clinical activities of inpatient admissions.
  • Quickly access clinical guidelines to better evaluate the appropriateness and medical necessity of services, facilities, and procedures.
  • Automate authorization processing and improve patient satisfaction.


When you have everything you need in one system, you won’t have to worry about spending extra on additional software. QuickCap has more features like EDI services, provider and health plan contracting, claims adjudication, data analytics, and more. So you can reduce UM administration costs, improve patient experience, and ensure the best quality of care that patients deserve.

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