The HealthEdge GuidingCare Solution Suite
GuidingCare Authorization Portal
An Intuitive Solution for Effortless Authorization Management
The GuidingCare® Authorization Portal takes the complexity out of preauthorization workflows with its intuitive, user-friendly design. It replaces outdated processes such as faxes and phone calls, delivering a modern, streamlined approach to managing preauthorization, appeals, and messaging cycles.
For an even more powerful solution, the portal integrates seamlessly with GuidingCare’s Utilization Management and Appeals & Grievances solutions. This end-to-end functionality ensures smooth, efficient workflows across all components, enabling your team to deliver better outcomes while saving time and reducing administrative burden.
Utilization Management staff and providers can collaborate seamlessly, reducing delays and administrative burdens. This efficiency leads to more satisfied teams, strengthened provider relationships, and improved member experiences. With seamless integration into industry-leading clinical guidelines, the Authorization Portal ensures decisions are grounded in evidence-based practices, fostering confidence and better outcomes across the board.
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GuidingCare Achieves AA Certification for HEDIS Measures Subset
GuidingCare Platform & Mobile Clinician App Earn CA Veracode Verified Status
GuidingCare Achieves NCQA Population Health Management Prevalidation
GuidingCare Platform Achieves HITRUST Certification
Features
Automated Rules & Configurations
Configure workflows and templates tailored to your plan design, line of business, regulatory requirement or quality measure. Routine requests can be authorized automatically with real-time data, while complex cases are flagged for review, reducing bottlenecks and boosting provider satisfaction.
Evidence-Based Clinical Guidance
Integrate seamlessly with trusted clinical guidelines, including MCG Cite AutoAuth and InterQual Connect™, to ensure every authorization decision is grounded in medically sound best practices.
Secure Direct Messaging
Bid farewell to inefficient phone calls and faxes. With built-in messaging capabilities, providers and utilization management staff can communicate directly and in real-time, streamlining the workflow and enhancing transparency.
Discharge Tracking
Track discharge plans and complete discharge assessments directly on the member’s authorization to improve care planning and coordination.
Integrated Platform
Offers seamless, end-to-end workflows when combined with GuidingCare’s Utilization Management and Appeals & Grievances solutions.
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Learn how our authorization software can help you streamline the preauthorization process and shrink turnaround times.
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HealthEdge Care-Payer Integration
HealthRules Payer is even more powerful when combined with GuidingCare®. Our unique Care-Payer Data Exchange solution provides the API-based integration that enables the continuous management of member care and core administrative processes.
Care-Payer provides a range of vital capabilities, including:
- Standardized core data delivery from HealthRules Payer to GuidingCare
- Authorization entry workflow improvement, including single-case agreement and referral category enhancement
- Near-real-time authorization delivery from GuidingCare to HealthRules Payer
Most notably, Care-Payer includes Benefit Predictor integration. This unique feature enables GuidingCare users to quickly and easily answer complex benefit questions prospectively from members and providers.
This Benefit Predictor integration is incorporated into several key workflows, giving Utilization Management staff and care managers unparalleled access to near-real-time benefits information.
Care-Payer Data Exchange delivers significant benefits to your organization, including:
- Smooth implementation through HealthEdge expertise and standardized processes
- Synchronized data sets between HealthRules Payer and GuidingCare
- New levels of operational efficiency in authorization entry and medical management
- Improved payment integrity
- Certified data exchange
HealthEdge Care-Wellframe Integration
HealthEdge Care-Wellframe is a scalable, flexible integration that brings together Wellframe and GuidingCare, our full-spectrum care management platform, into one unified solution that offers health plans a comprehensive package with the right tools to transform their care management function.
The Care-Wellframe integration enables health plans to:
- Streamline Care Management Workflows: A fully integrated solution provides care managers with a comprehensive member view through a singular care management platform – no more swivel chair.
- Enhance Member Engagement: Meet members where they are on their own terms through omnichannel communication and a multi-modal digital front door.
- Scale Care Management Resources: Maximize care manager efficiency and support more members with dynamic decision support tools, alerting logic, and instant access to clinical and community SDOH resources.
With Care-Wellframe, health plans unlock the power to revolutionize care management operations and elevate member outcomes through a seamless, unified solution designed for impact and scalability.
LEARN MOREExplore the GuidingCare Solution Suite
GuidingCare® Comprehensive, Configurable, Connected
GuidingCare offers a comprehensive suite of modules tailored to meet the evolving needs of healthcare payers and providers. Designed to operate seamlessly within your existing ecosystem, our solutions ensure interoperability, adaptability, and future-proofed capabilities for today's evolving care environments.
Learn MoreGuidingCare Care Management
Effectively operationalize an evidence-based, person-centered care strategy with workflows that align with NCQA standards, CMS guidelines, and personalized care requirements. Enhance operational efficiency while enabling care teams to identify gaps and take targeted actions.
LEARN MOREGuidingCare Utilization Management
Simplify and optimize the complete authorization lifecycle with advanced tools that integrate clinical guidelines, predictive modeling, and AI-driven workflows to boost productivity and reduce administrative bottlenecks.
LEARN MOREGuidingCare Authorization Portal
Streamline provider interactions with an intuitive tool for preauthorization, messaging, and appeals. Empower providers and staff with an interface designed for clarity and simplicity while ensuring alignment with compliance standards.
Learn MoreGuidingCare Appeals & Grievances
Streamline the appeals and grievances process to meet regulatory demands with automated workflows, task tracking, and correspondence. Configurable tools ensure compliance and timely resolutions for all grievance types.
Learn MoreGuidingCare Business Intelligence
Make smarter decisions with over 50 standard reports and an actionable analytics suite. Uncover trends, build ad hoc reports, and transform data into strategic insights.
Learn MoreGuidingCare Population Health Management
Leverage advanced gaps-in-care analytics to identify high-risk members, prioritize interventions, and optimize health outcomes. Empower care teams with SDOH and analytics to address risk factors and inequities for more effective care.
Learn MoreAdvanced Tools for Transformation
GuidingCare University
Empower your team with our self-service digital training platform offering on-demand, video-based learning to optimize user interaction with the GuidingCare Solution Suite.
LEARN MOREGuidingCare Rules Designer
Independently create, manage, and deploy business rules into your GuidingCare instances to automate workflows and decision-making.
LEARN MOREGuidingCare Pediatric Population Health Management
Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.
LEARN MOREGuidingSigns® Analytics
A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.
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