The GuidingCare Solution Suite
The GuidingCare® Utilization Management module supports the authorization lifecycle – from request and review to status determination to correspondence with members and providers. Helpful clinical guidelines and configurable authorization management workflows help you manage utilization effectively.Learn More
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
Streamlines moving parts in the complex UM process, including Peer Reviews, MD Reviews, and Concurrent Reviews.
Turnaround Time Requirements
Maintain compliance across all lines of business with configurable turnaround time (TAT) by benefit program and authorization type, for review, approval, correspondence and other activities.
Adjusts to your organization’s specific needs and supports clinically sound workflows for authorizations, reviews and service approvals. Templates automatically pre-populate data to save time and improve accuracy.
Integration between MCG Cite AutoAuth and InterQual Connect support automated decision-making and extensive integration with MCG and InterQual provides users direct access to evidence-based clinical guidelines, so review details are saved against each request, supporting the decision process.
Integrates seamlessly with the GuidingCare solution suite, enabling all stakeholders to track the progress of appeals, along with enrollment, encounter, and care planning information.
Request a Demo
See how your team can benefit from a utilization management solution with a single, comprehensive care record and streamlined authorization and decision workflows.REQUEST A DEMO
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
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.Learn More
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.LEARN MORE
GuidingCare Utilization Management
Our Utilization Management module supports the complete authorization lifecycle, including clinical guidelines and authorization management workflows.LEARN MORE
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.Learn More
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.Learn More
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.Learn More
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.Learn More
GuidingCare Medication Therapy Management
Enable pharmacists with a central location in which they can manage member medications and intervene to prevent potentially harmful outcomes.LEARN MORE
GuidingCare Pediatric Population Health
Standard and enhanced tracking and reporting to meet federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements in Medicaid.LEARN MORE
A clinical decision support system that transforms data into actionable insights for health care payers and providers.LEARN MORE