One of the first, most important decisions your staff can make occurs early in the patient assessment process: Should care be provided at the observation or inpatient level? This “fork in the road” decision can have significant consequences, as incorrect choices can lead to misuse of limited resources and costly denials. Unfortunately, recruiting knowledgeable, experienced staff to guide these decisions can be a challenge. Utilization Management Services help to ensure patients receive the most appropriate level of care while helping to reduce medical necessity denials. Our expert staff provides initial/prospective reviews on admission to determine the appropriate care setting. These include: • Placement-status reviews using InterQual or another evidenced-based, clinical decision-making tool • Concurrent authorization services for admissions • Additional scrutiny when decision-support tools conflict with a physician’s clinical judgement, with additional documentation for medical necessity of care We function as an extension of your Case Management or Utilization Review department, working in your unique environment and using your technologies and tools. Our remote support allows your onsite staff to expand the number of cases you review and to focus on length of stay and highly complex cases that need specific clinical expertise. Business Insights Drive Continuous Improvement: We use reporting and analytics to keep you informed of performance so you can track the return on investment. Our reports include: • Trending on Level of Care denials • Percentage of daily reviews completed concurrently at the time of admission • Percentage of accounts requiring authorization completed • QA scores that reflect how accurately your nursing staff is applying decision-support technology and how consistently they are documenting it in your system • Percentage of clinical submissions that meet payer and timing requirements versus those that miss filing deadlines and are returned as concurrent denials A Flexible Resource: You can engage our services to augment your existing staff or use our team as a complete solution. We can also provide a bridge to in-sourcing by educating and training your team, helping you to build a strong internal prospective review program.

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

InterQual AutoReview™ is a unique cloud-based solution that automates the InterQual® Initial and Episode Day 1 medical reviews at the point of the admission decision, using real-time data from your EHR. This breakthrough in robotic process automation can eliminate up to 75% of the time it takes your UM staff to conduct InterQual reviews, and allows them to focus on the exceptions that require their clinical expertise. The solution also provides real-time decision support, potentially reducing inappropriate admissions and denials. Integrated in Your Workflow: This flexible solution as a service (SaaS) is integrated into leading EHR applications and connected to case management systems. Automatically Conducts an InterQual Review Right from the EHR: Simply submit an order to admit from your EHR, and InterQual AutoReview springs into action—extracting the necessary data to create and populate InterQual Initial and Episode Day 1 reviews. Includes Data from the Source of Truth: Automated reviews eliminate manual data-entry errors and contain the clinical values extracted from the EHR. The result is an accurate medical review that promotes transparency and trust between providers and payers. Transmits Reviews Directly to the UM/CM System: Staff can validate reviews and make any necessary edits from within their existing workflow. Authorization requests can then be sent to payers using InterQual Connect™ at a time the hospital chooses. Provides Instant Notification Back to the EHR: Ordering clinicians see the care determination as soon as the admission order is submitted. Providing clinical decision support at the point of decision helps clinicians ensure the appropriate level of care is chosen from the start. Leverages Natural Language Processing (NLP): Many critical pieces of clinical information are stored in free text, such as imaging narratives. NLP models, trained by clinical experts, extract discrete clinical data from this text to complete specific criteria points within the InterQual review. Extracts Clinical Data to the Cloud: The auto-review process is launched the moment a clinician submits an order to admit. Using the diagnosis as a guide, InterQual AutoReview sorts through multiple sources of information, both structured and unstructured, within the EHR. It extracts the relevant clinical data available at the moment of admission and transmits it securely to the cloud. The process continues to run, extracting new and updated data every 2-4 hours, up to 24 hours from the time the order was submitted. Prepares InterQual Reviews: Using robotic process automation and NLP, InterQual AutoReview analyzes the structured and unstructured data acquired from the EHR at the moment of admission and maps the discrete data to the codified InterQual Criteria. Next, the solution creates InterQual Initial and Episode Day 1 Reviews, and transmits them to your participating UM/CM system. Over the next 24 hours, the solution uses the new clinical data extracted from the EHR to update the Episode Day 1 Review in the UM/CM system. At any time during that 24-hour period, a case manager can evaluate the Episode Day 1 Review, and save or complete it. This will halt the update process, and allow the case manager to use the automated review in your normal approval workflow. Security: Information security is of the utmost importance, and compliance is complex. InterQual AutoReview has met the rigorous standards required to protect your sensitive data and is HITRUST-certified.

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.