Make informed decisions in real time
The process of collecting, normalizing and reviewing clinical information is expensive for all parties. The process of validating criteria through the manual review of medical records can range from $10 to over $100 per each individual chart review. In addition, each year new treatment guidelines and procedures that impact the overall cost and treatment of members are made available. Health plans, insurance companies and clinicians must ask for more information to evaluate requests for treatment and procedures. Acquiring and evaluating the clinical data often results in inefficiencies, excess overhead costs and wasted time. All stakeholders – providers, insurance companies and patients – suffer due to the complex nature of these requests.
Lower review costs while improving patient care
SPOT automates the discovery of critical insights from health records and evaluates coverage and authorization requirements for treatment either before or after a claim is submitted. SPOT also evaluates incoming faxes to complete the clinical picture and incorporate non-structured information into existing review workflows.
SPOT revolutionizes the intelligent analysis of clinical information at critical points of care and optimizes risk-based decision support by leveraging existing interoperability standards and Artificial Intelligence (AI).
In just 30-45 days, you’ll see the value.
SES SPOT offers clear, fast benefits, with subscribers reporting value to their bottom lines in under six weeks. Automate the review of clinical information for use in medical review necessary for prior-authorization and payment of services, care coordination and claim management.