The HealthEdge GuidingCare Solution Suite
AI-Powered Care Solutions
Achieve Excellence with AI-Driven Automation
Health plans face growing challenges in improving performance and outcomes. Manual utilization management (UM) processes drive up costs, delay care, increase provider abrasion, and complicate compliance. It’s time for a smarter solution.
- High Costs: Prior authorizations contribute approximately $35 billion annually to U.S. healthcare administrative spending.
- Delays in Care: Manual reviews create bottlenecks, causing 94% of patients to experience delays in care.
- Regulatory Pressure: Evolving standards, such as CMS-0057-F, demand rapid, transparent, and fully auditable decision-making.
- Provider Abrasion: Inefficient processes strain provider-payer relationships, leading to frustration and reduced collaboration.
Disconnected technologies and manual interventions limit the flexibility health plans need, slowing adaptation and hindering continuous improvement in addressing today’s utilization management demands.
The Next Generation of AI-Driven Clinical Decision Intelligence
The HealthEdge GuidingCare® Decision Intelligence Ecosystem represents a transformative leap in clinical decision intelligence, leveraging rapid advancements in AI and automation to streamline utilization management for health plans. Purpose-built to unify fragmented processes, GuidingCare embeds best-in-class AI decision-making capabilities from leading healthcare AI vendors directly into daily workflows. This AI-first strategy enables payers to accelerate case determinations, optimize costs, and achieve agile, intelligent automation—all while advancing compliance and supporting measurable operational improvements.
Advancing Innovation Through Strategic Industry Collaboration
GuidingCare integrates with premier AI innovators to transform utilization management. This flexible ecosystem allows health plans to deploy next-generation workflows that enhance operational performance and efficiency.
Anterior:
Replicates human clinical reasoning with 99.24% KLAS-validated accuracy to scale AI-powered workflows and minimize administrative burden.
Latitude Health:
Leverages advanced clinical expertise to automate up to 75% of manual tasks, delivering frictionless determinations and a potential 10:1 return on investment.
Case Health AI:
Specializes in automating prior authorizations with deep clinical expertise, allowing plans to ingest and analyze requests with unparalleled speed and precision.
Discover What’s Next in Utilization Management Innovation
Experience the confidence that comes with advanced, intelligent automation and seamless compliance. See how GuidingCare empowers your organization to achieve greater agility and drive lasting operational excellence in prior authorization workflows. Schedule your personalized demonstration today.
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