A payer needs to work with plan members and medical providers to influence decisions through a case-by-case review of the appropriateness of care.
When gathering requirements for this use case, which two Utilization Management processes should a consultant discuss with the client?

Question

A payer needs to work with plan members and medical providers to influence decisions through a case-by-case review of the appropriateness of care.

When gathering requirements for this use case, which two Utilization Management processes should a consultant discuss with the client?

najim faryabi · Accepted Answer

Designing Care Requests to seek authorization from a health plan for drugs, services, and admissions

najim faryabi · Accepted Answer

Considering the Request Review Types; Prior Authorization Review, Concurrent Review, and Retrospective Review

najim faryabi · Answer

Designing Next Best Action and Recommendations for the care management team

najim faryabi · Answer

Considering the number of intake agents who will be using Health Cloud

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