with new management challenges. Healthcare organizations across the country must now comply with an increasing number of insurance certification and authorization requirements--before... services are rendered. In addition to identifying certification-related requirements, follow-up must occur to assure that all required activities have been completed. Multi-Faceted... Needs to Identify Certification Requirements Healthcare organizations must be equipped with the capability to identify patient insurance requirements before services are rendered...

, insurance, and clinical data--as defined by the facility (e.g., payors, planned procedures). ...specific rules that apply to this encounter (e.g., a certification requirement that results... for a Medicare patient with non-covered services). ...to help assure that tasks related to the matched rules are completed (e.g., the required certification number is obtained and recorded.... Insurance Certification Captures patient's payor, employer, and planned procedure data. Identifies rules related to the patient's insurance and/or managed care contract requirements...

processes. These products assist with patient access activities, insurance requirements/payments, and coordination of patient care support processes (e.g., case management... the characteristics (or values of particular data elements) for that patient. An Aetna outpatient has different requirements (or rules) than an Aetna inpatient or a Blue Cross... outpatient or a Medicare outpatient. Huron's software allows a healthcare institution to identify the various requirements for each patient, and to help assure that all...

items-which identify particular rules and tasks. 1. Captures Patient Data demographic, insurance, and clinical data 2. Identifies Specific Requirements by screening against your...

and outpatient encounters.) 2. Identifies ...specific managed care requirements (e.g. pre-admission testing, pre-certification) 3. Notifies ... key personnel and departments...