The GuidingCare Solution Suite

Authorization Portal

Intuitive Prior Authorization Platform for Healthcare Providers

The GuidingCare® Authorization Portal offers an intuitive and comprehensive authorization management platform to ease the preauthorization, appeals, and messaging process for your Utilization Management staff and the providers who interface with your plan.

Plans can dramatically streamline the preauthorization process and shrink turnaround times by eliminating time-consuming faxes and phone calls. The reduced administrative burden ensures more satisfied staff, providers and plan members. Best of all, the Authorization Portal integrates with the world’s most comprehensive and respected clinical guidelines.

Prior authorization portal overview

GuidingCare Achieves AA Certification for HEDIS Measures Subset

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GuidingCare Platform & Mobile Clinician App Earn CA Veracode Verified Status

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GuidingCare Achieves NCQA Population Health Management Prevalidation

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GuidingCare Platform Achieves HITRUST Certification



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Rules and Procedures

Configure workflows and templates to meet requirements according to the plan design, line of business, regulatory requirement or quality measure. Real-time data can automatically authorize routine requests and flag those that need further medical review, reducing administrative burden and increasing provider satisfaction.

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Clinical Guidance

Pre-built integrations with MCG Cite AutoAuth and InterQual Connect™, the world’s most comprehensive and respected clinical guidelines, provide confidence coverage decisions are grounded in best practices.

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Direct messaging between providers and utilization management nurses eliminates inefficient phone and fax communications.

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Discharge Tracking

Track discharge plans and complete discharge assessments directly on the member’s authorization to improve care planning and coordination.

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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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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
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The GuidingCare Solution Suite


GuidingCare is a comprehensive solution for whole-person, patient-centered care, offering easy-to-use, next-generation data integration and workflow management solutions and tools. Our feature-rich solution suite is easy to integrate with existing systems and is highly configurable.

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GuidingCare Care Management

Our Care Management workflow software provides tools that help you operationalize an evidence-based, person-centered care management strategy for your populations.

GuidingCare Utilization Management

Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.

GuidingCare Authorization Portal

This intuitive and comprehensive electronic tool eases the preauthorization, appeals and messaging process for your Utilization Management staff and the providers who interface with your plan.

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GuidingCare Business Intelligence

Our Reporting & Business Intelligence module provides more than 50 standard reports to make ad hoc report-building and analysis simple and actionable.

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GuidingCare Population Health

Our web-based care coordination application for provider partners incorporates gaps-in-care analytics that enables clinical staff to identify high-risk patients and potential health improvement opportunities.

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GuidingCare Appeals & Grievances

Our Appeals & Grievances module streamlines and consolidates the entire appeals management process to help you meet regulatory demands for timely resolution and correspondence.

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Additional Offerings

GuidingCare Medication Therapy Management

Enable pharmacists with a central location in which they can manage member medications and intervene to prevent potentially harmful outcomes.

GuidingCare Pediatric Population Health

Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.

GuidingSigns® Analytics

A clinical decision support system that transforms data into actionable insights for healthcare payers and providers.