Care & Utilization Management

[vc_row padding_top=”80px”][vc_column][ultimate_spacer height=”50″][ultimate_heading main_heading=”Care & Utilization Management” main_heading_font_size=”desktop:30px;” sub_heading_margin=”margin-top:10px;” main_heading_font_family=”font_family:Roboto|font_call:Roboto|variant:regular” main_heading_style=”font-weight:normal;font-style:normal;” sub_heading_font_family=”font_family:Roboto|font_call:Roboto|variant:300″ sub_heading_style=”font-weight:300;” sub_heading_line_height=”desktop:28px;” sub_heading_font_size=”desktop:18px;”]Value-based care requires care, utilization and case management to work in synchrony.[/ultimate_heading][ult_animation_block animation=”bounceIn” animation_duration=”1″ animation_delay=”0″ animation_iteration_count=”1″][ultimate_spacer height=”50″][vc_column_text]

Cozeva offers an integrated utilization and care management platform that delivers seamless interoperability with other healthcare technologies.  To achieve value-based care, we designed a comprehensive solution to automate UM workflows and provide real-time coordination between systems. We are committed to helping you make evidence-based decisions for your members. To maximize the value of our solution, we also provide tools to ensure you are compliant with reporting requirements and policies and procedures. We believe in leveraging technology to eliminate any unnecessary work, so your staff can work efficiently to provide quality care to your members.

[/vc_column_text][ultimate_info_banner banner_title=”How it works” info_effect=”zoomIn” banner_size=”30″ button_color=”#65af36″ ib3_background=”#ffffff” title_font_size=”desktop:30px;”][info_list position=”top” style=”hexagon” icon_bg_color=”#7e0493″ icon_color=”#ffffff” font_size_icon=”24″ eg_br_width=”1″][info_list_item list_title=”1. Fill-out Prior Authorization Form by Physician” list_icon=”Defaults-file-text-o” title_font_color=”#666666″ title_font_size=”desktop:14px;”]Look up eligibility


Pre-filled with all known patient information


Add ICD-10 code(s) and CPT/HCPCS code(s)


Quick find rendering provider from the recent visits or Cozeva Provider Directory


Automatic validation against patient benefit, the validity of codes, out-of-network provider, codes do not require a PA, provider not offering the services etc.


Automatic suggestion of required documents[/info_list_item][info_list_item list_title=”2. Prior Authorization Sent to Payer” list_icon=”Defaults-paper-plane send” title_font_color=”#666666″ title_font_size=”desktop:14px;”]X12 EDI 278 transaction supported


Ruled based validation for auto approval


Prior Auth Request is auto-assigned to the correct UM staff


Auto determination of due-date for prior auth based on compliance criteria


Real-time task dashboard for easy tracking and planning for UM staff[/info_list_item][info_list_item list_title=”3. Smart Document upload” list_icon=”Defaults-cloud-upload” title_font_color=”#666666″ title_font_size=”desktop:14px;”]Several channels to upload documents to Cozeva – all are Secured & HIPAA compliant


Patient records from integrated EHR automatically attached to the Prior Authorization


Cozeva Secure Gateway mobile app help capture and upload documents instantly


Cozeva eFax solution auto-tags the document to the right patient


Easy search for attachments in the patient document hub[/info_list_item][info_list_item list_title=”4. Prior Authorization Approval” list_icon=”Defaults-check-circle” title_font_color=”#666666″ title_font_size=”desktop:14px;”]Integrated with MCG CareWebQI for medical necessity determination


Ability to reassign authorizations based on complexity of the request


Real-time notification to provider and patient regarding the status of the authorizations


Streamlined process to extend expired authorizations


Supports best practice denial templates[/info_list_item][/info_list][/ult_animation_block][vc_row_inner css=”.vc_custom_1433880340656{margin-top: 50px !important;}”][vc_column_inner width=”1/2″][ult_animation_block animation=”slideInLeft” animation_duration=”1″ animation_delay=”0″ animation_iteration_count=”1″][ultimate_heading main_heading=”Problems we are addressing” heading_tag=”h3″ alignment=”left” main_heading_font_size=”desktop:24px;” main_heading_margin=”margin-bottom:30px;”][/ultimate_heading][ultimate_spacer height=”20″][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”Providers have to manually upload or send patient documents” title_font_size=”desktop:15px;”][/bsf-info-box][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”UM staff have to attach documents to the authorizations” title_font_size=”desktop:15px;”][/bsf-info-box][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”Out-of-date in-network provider directory” title_font_size=”desktop:15px;”][/bsf-info-box][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”No visibility to patient appointment status after an authorization is approved” title_font_size=”desktop:15px;”][/bsf-info-box][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”Inefficient workflows and difficulty prioritizing day to day tasks” title_font_size=”desktop:15px;”][/bsf-info-box][bsf-info-box icon=”Defaults-times-circle” icon_size=”22″ icon_color=”#dd9933″ title=”Lack of member engagement and delayed care” title_font_size=”desktop:15px;”][/bsf-info-box][/ult_animation_block][/vc_column_inner][vc_column_inner width=”1/2″][ult_animation_block animation=”bounceInRight” animation_duration=”3″ animation_delay=”0″ animation_iteration_count=”1″][ultimate_heading main_heading=”Our Goals” heading_tag=”h3″ alignment=”left” main_heading_font_size=”desktop:24px;” main_heading_margin=”margin-bottom:30px;”][/ultimate_heading][ultimate_spacer height=”20″][bsf-info-box icon=”Defaults-copy files-o” icon_size=”32″ icon_color=”#83ad35″ title=”Cut down time to process an authorization due to missing or inappropriate documentation. Prevent delay in patient care. We know what to send.” title_font_size=”desktop:13px;”][/bsf-info-box][bsf-info-box icon=”Defaults-paperclip” icon_size=”32″ icon_color=”#83ad35″ title=”Upload documents from anywhere, we automatically attach it to the authorization. No manual labeling anymore!” title_font_size=”desktop:13px;”][/bsf-info-box][bsf-info-box icon=”Defaults-group users” icon_size=”32″ icon_color=”#83ad35″ title=”Stay current on in-network provider directory and patient eligibility & benefit for your best reference anytime!” title_font_size=”desktop:13px;”][/bsf-info-box][bsf-info-box icon=”Defaults-check-square-o” icon_size=”32″ icon_color=”#83ad35″ title=”Stay compliant. We will assign, prioritize and arrange your tasks so that you never miss a deadline!” title_font_size=”desktop:13px;”]

[/bsf-info-box][bsf-info-box icon=”Defaults-calendar” icon_size=”32″ icon_color=”#83ad35″ title=”Enable UM staff to track appointments post approval of the authorizations ” title_font_size=”desktop:13px;”][/bsf-info-box][/ult_animation_block][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][ultimate_spacer height=”20″][ult_animation_block animation=”bounceInUp” animation_duration=”3″ animation_delay=”0″ animation_iteration_count=”1″][ultimate_heading main_heading=”List the Benefits” heading_tag=”h3″ alignment=”left” main_heading_font_size=”desktop:24px;” main_heading_margin=”margin-bottom:30px;”][/ultimate_heading][ultimate_spacer height=”20″][info_list icon_bg_color=”#83ad35″ icon_color=”#ffffff” font_size_icon=”24″ eg_br_width=”1″][info_list_item list_title=”The Utilization Management portal and Real-time Dashboards” list_icon=”Defaults-check”]The UM portal provides a secure communication platform with the providers and patient, a 360° view of the patient records, appointments, encounters. The task-based real-time dashboard makes the day-to-day work management super efficient. The performance dashboard provides high-level reports of the health-plan staff performance and outcome.[/info_list_item][info_list_item list_title=”Rules-driven workflow” list_icon=”Defaults-check”]Easy to configure. Benefit-rules. Rules can automate assignment, load distribution, pre-approval.[/info_list_item][info_list_item list_title=”Integrated with provider & patient portal” list_icon=”Defaults-check”]The provider portal is integrated with the UM system. Providers get a highly automated tool to create and send an authorization request. Enabled with real-time tracking, secure messaging with UM staff and patient. Cozeva Personal, the patient portal is also integrated to keep the patient informed about the status at any-time.[/info_list_item][info_list_item list_title=”Real-time action driven notification” list_icon=”Defaults-check”]Notify providers when an action is required. Notify patient upon decision.[/info_list_item][info_list_item list_title=”Easy document upload via Cozeva Exchange” list_icon=”Defaults-check”]EHR integration keeps your patient records accessible in Cozeva. The Cozeva Secure Gateway mobile app makes it easier to capture and attach documents to the right patient and authorization.[/info_list_item][info_list_item list_title=”Patient-centric document hub” list_icon=”Defaults-check”]No need to go through each prior auth request to find a patient document. The document hub gives you the overall picture of all documents available for a patient and are timestamped. Advanced search is enabled.[/info_list_item][/info_list][/ult_animation_block][/vc_column][/vc_row]