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Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Differentiators
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Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Differentiators
Keywords
Media
Company details

Categories

Solutions

Description

Product Description:
VALER is a cloud-based **Enterprise Authorization Platform** that streamlines and automates today's manual authorization workflows. VALER provides **ONE place to SUBMIT and VERIFY authorizations across all payors and all services types** (professional, facility, ancillary, medications, etc). VALER is the only solution that manages authorization submissions for both payor **FAX** and **web portal** based workflows. VALER provides enterprise-wide visibility on **real-time authorization status** and documentation to eliminate duplicate work and support the revenue cycle.
About Valer:

Valer provides innovative, cloud-based workflow optimization and automation solutions for administrative healthcare transactions.

Our Valer platform streamlines and automates prior authorizations, eligibility verification, and referrals document management in one, easy-to-use workspace. Valer eliminates paper fax and integrates with payer web portals to automate prior authorizations. Valer improves office staff productivity and reduces the cost of managing prior authorizations. Valer eliminates manual data entry errors with prior authorizations that impact the revenue cycle. Valer delivers the benefit of automated electronic transactions today with zero client installs and zero interoperability requirements.

Product Description:

Care Continuity's PCP-to-Specialist Referral Management is a data-driven patient navigation designed to increase PCP-to-specialist completion rates and improve utilization of your aligned provider network by improving appointment completion rates for your most profitable service lines.

Care Continuity leverages a purpose-built software that utilizes AI and machine learning to analyze dozens of data points and social determinants of care that make it possible to prioritize patients for outreach based on their need, and to maximize the downstream effectiveness of a patient navigation program. In addition, the software is supported by a team of trained concierges that do the navigating on your behalf, allowing your team to continue working at the top of their license.

In addition to higher specialist attachment rates, health systems that utilize Care Continuity's PCP-to-Specialist program gain valuable insights into their network performance. Curated data dashboards provide an in-depth look at referral appointment completion percentages, procedure-to-appointment rates, median times to appointment, and more. This data can also be viewed at the service line and facility level, giving actionable insights into potential areas for growth.

About Care Continuity:

Founded in 2014, Care Continuity provides expert patient navigation solutions that are designed to bridge gaps in healthcare, providing seamless transitions between care settings, reducing network leakage, and promoting optimal health outcomes and patient satisfaction. Through a combination of advanced software, AI and a dedicated team of care concierges, we help guide patients through their care journey while maintaining the integrity of the health system network. This translates to greater patient satisfaction, better health outcomes, and increased margins for our clients.

Compatibility level

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Clients

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Product Capabilities

VALER can be configured to identify highly targeted information regarding authorization requirements and/or services which are "no auth required." VALER has the ability to work with select payers to provide authorization requirements, "no auth required" alerts, and authorization submissions via real-time APIs (application programming interfaces) where available.

VALER maintains both historical data on actual authorization requirements (clinical data and relevant provider, facility data) and has the ability to implement highly targeted business rules to avoid unecessary errors and denials.

VALER comprehensively automates completion and submission of prior authorizations for 1,000+ unique payer fax forms and 75+ payer web portals.

VALER's form library maintains and updates over 1,000+ payer authorization fax forms across all service lines (diagnostic imaging, surgeries, procedures, chemo/infusion, medications, notice of admissions, DMEs, sleep, Worker's Comp). VALER's proprietary technology can add any new fax form for users typically within 24 hours to support authorizations and referrals.

VALER provides the ability for users to easily attach any relevant clinical documentation to a prior authorization for submissions. VALER supports various file formats needed for submission. VALER also captures documentation from payers regarding approval tracking codes, expiration dates, units of service, CPTs approved, which can be pushed directly back into EHRs/practice management systems to avoid manual data entry. VALER also has Epic's x275 clinical document exchange functionality live in production to directly exchange information from Epic to VALER and back.

VALER comprehensively SUBMITS prior authorizations across both fax and web portal modalities across all-payers and all service types. VALER provides ONE interface, deeply integrated with EHR workflows to automate both today's manual authorization submission and verification workflows.

VALER provides automated authorization status verification across 75+ payer web portals. Authorization information (tracking numbers, units, expiration dates, sites of service, CPT/family of codes approved can be automatically pushed back into EHRs in an automated process further eliminating the need for manual data entry.

Care Continuity's software solution support bi-directional integration with the ability to ingest applicable data from a health system's EHR, as well as repopulate any applicable system post-navigation.

All of Care Continuity's systems meet HIPAA requirements and are HITRUST r2 Certified.

Care Continuity's software solution is designed to handle hospitals and health systems of any size. Today, Care Continuity works with a number of the largest health systems in the nation, medium-sized systems, and standalone institutions.

Care Continuity's patient navigation platform is equally proficient in both FFS and value or risk-based arrangements. Our product and software development teams boast decades of experience in the healthcare industry with a specific focus on patient navigation and provider network management.

Use Cases

Description:

VALER provides health systems, hospitals, and ambulatory clinics with one place to streamline, automate, and manage today's manual prior authorization workflows. VALER saves time, cost, and reduces patient access denials and avoidable write-offs.

Pediatric use cases:

Pediatric health systems and clinics utilize VALER to reduce the time and cost involved with today's manual prior authorization and referral workflows.

Users:

patient access teams, ambulatory clinic authorization teams,  admitting/scheduling teams, revenue cycle teams

Description:

A health system is looking for ways to drive more patients to their cardiology service line. Historically, cardiology has been one of their more profitable service lines. With a provider network featuring multiple facilities and other service lines, the system has struggled to track the downstream progress of a patient after their primary care referral. 

Leveraging Care Continuity's PCP-to-Specialist Referral Management solution, a data feed of referrals is sent to Care Continuity where the software's AI uses dozens of data points -- including diagnoses, discharge notes, patient information, social determinants of health, and more -- as well as a set of customizable prioritization rules to create a navigation queue for a team of expert navigators to personally contact and navigate.

This allows for a multi-dimensional approach to patient navigation that can predict which patients are most in need of, as well as open to, navigational assistance. 

The trained team of navigators contact the patients based on their priority ranking and can coordinate the specialist appointment between both patient and office. On average, a patient navigator can schedule a higher percentage of appointments at a faster rate when compared to other self-navigation methods. In addition, appointments scheduled via a patient navigator are statistically less likely to result in a no-show. 

After the program is implemented, health system stakeholders receive a data dashboard that shows the downstream impact of the navigation, including the total number of appointments scheduled, the number of completed appointments, the number of appointments that required procedures, and median time to appointment. 

With this data broken down by both service line and facility, a health system can focus on a profitable service line such as Cardiology, looking for areas to improve their network and make a positive financial impact. 

Pediatric use cases:

None provided

Users:

Medium to extra-large health systems

EHR Integrations

Integrations:

Acute care EMR, Ambulatory EMR, Community based organizations, ADT, Access +/or revenue cycle, Website / public online sources

EMR Integration & Relevant Hardware:

Recommended, but not required

EMRs Supported:

Epic, Cerner, Allscripts, NextGen, athena

Hardware Compatibility:

Desktop

Integrations:

Acute care EMR, Ambulatory EMR, Ancillary EMR, ERP system, Patient portal, Pop health platform

EMR Integration & Relevant Hardware:

Required

EMRs Supported:

Epic, Cerner, Meditech, Allscripts, NextGen, athena, GE, eClinicalWorks, McKesson

Hardware Compatibility:

Not applicable

Client Types

Differentiators

Differentiators vs EHR Functionality:

VALER provides comprehensive coverage of **all payor authorization workflows (fax, phone, web portals) ** and rapidly updates new or changing authorization requirements.

VALER serves as a **single point of integration** and maintains changing requirements for all payor authorization workflows across fax, phone, and web portals.

VALER flexibly integrates with EHRs and practice management systems to reduce manual data entry and scanning of documents

Differentiators vs Competitors:

VALER streamlines and automates today's highly manual **AUTHORIZATION SUBMISSION** and **VERIFICATION** workflows with proven results of 45% reduction in staff time and 11% improvement in staff productivity.

VALER covers **all service types** including professional, facility, technical, medications, and DME authorization workflows
VALER provides **real-time data** on authorization processing times, staff productivity, payor behaviors/turnaround time to optimize prior authorization workflows VALER allows for **coordination and collaboration across the enterprise** to reduce duplicate work and errors between ambulatory clinics, facility admitting/scheduling, and the revenue cycle teams.   

VALER promotes **clean claims** by **standardizing** and **streamlining** authorization submission by injecting **payer rules** in the workflow to reduce costly denials

Differentiators vs EHR Functionality:

Leading EHR functionality takes a very basic approach to patient navigation. When utilized, the EHR prioritization queue is binary, labeling every patient as urgent or non-urgent. Instead, Care Continuity not only expands the total number of evaluated data points needed to properly prioritize a patient, but Care Continuity also expands the priority listing to 10 levels, allowing for a more nuanced and tailored navigational experience. 

In addition, the EHR functionality requires the health system to staff a team of navigators. Unfortunately, this largely non-clinical function is staffed by clinical staff, severely hampering their ability to work at the top of their license. 

Care Continuity pairs their purpose-built software with a team of trained, non-clinical concierges who are experts in patient experience and proper navigation.

Differentiators vs Competitors:

With more than a decade of experience working with the nation's leading health systems, Care Continuity has had the honor of navigating millions of patients through the healthcare continuum. 

Leveraging purpose-built software with proprietary algorithms designed to efficiently navigation patients, Care Continuity can provide a customizable, high-ROI solution for health systems of any size.

Keywords

Images

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Sample Referral Dashboard

Videos

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Company Details

Founded in 2010

Founded in 2008

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