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Cortex

Cortex

Cortex

By Xsolis

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Utilization Review Automation and Denial Prevention
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Overview



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Description

In the complex environment of Case Management and Utilization Review, a people-driven process inherently leads to error and lost revenue. To optimize the process to capture appropriate revenue, prevent denials and reduce Length of stay requires people and their ability review a case consistently. The legacy tools accessible today create a process highly dependent on human capital. What humans can’t do, Artificial Intelligence can. XSOLIS uses Artificial Intelligence (AI) to predict appropriate patient status (observation vs. inpatient), build automated defense of patient status, and identify Length of Stay reduction opportunities. Our technology can now interpret a medical record more accurately and more often than a person in many cases, and technology becomes unparalleled when it isolates risk in the complexity of a hospital today so issues can be mitigated in real-time. To assess a case today – the appropriate patient status, denial risk, and when a patient is ready for discharge – involves highly complex processes with thousands of variables and decision trees that are reliant on a manual review process. The XSOLIS Cortex platform transforms the manual review process today and automatically interprets a patient’s medical record in real-time. It automatically suggests appropriate status, brings awareness to revenue sensitive cases, drives intervention to denial mitigation situations (in real-time where it’s most preventable), and identifies Length of Stay opportunities to ensure highly efficient operations. Over 150 hospitals are currently contracted with XSOLIS and have seen significant results in denial prevention, throughput, Length of Stay, appropriate status conversions, and more. Automation has significantly impacted their revenue capture and has also shifted high value resources toward higher value processes – the clinical, not the clerical.
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Company information

Founded in 2013

79.0M total equity funding

Verify your employment with a hospital or health system and see a personalized match score.
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Reviewer’s Role
  • End user
  • Project manager
  • IT / Technical support
  • Executive sponsor
  • Internal consultant
  • Other

Reviewer’s Org Size
  • XL ($5B+ NPR)
  • L ($3-5B NPR)
  • M ($1-3B NPR)
  • S ($0.2-1B NPR)
  • XS (< $0.2B NPR)

Reviewer’s Org EMR compatibility

Reviewer’s Org Type
  • AMC
  • Pediatric Facilities
  • ACO
  • Rural Presence

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