Companies involved in Workers’ Compensation will typically use Utilization Review, Case Management and Claims Management software independent of one another. The Ahshay core software platform achieves higher efficiency, savings, and detailed reporting by combining these modules under one platform.
Within DataCare‘s core platform Ahshay, Utilization Review, Case Management, and the claim enhancing Medical Process Manager (MPM) modules provide streamlined tools to their users. Even greater workflow optimization can be achieved by combining these three modules in Ahshay. Necessary and appropriate information can be easily shared through the system interface.
As a stand-alone product, the Ahshay UR module has the capability to auto-generate and send out (email & fax) determination letters while incorporating state/jurisdictional guidelines and turnaround times. All determinations are tracked and users are able to run real-time management queries to show approvals, denials, turnaround times, etc. for unprecedented bench-marking in UR management.
The Ahshay Case Management module auto generates patient progress reports that can be sent directly from the system (email & fax), and additionally incorporates guideline-driven return-to-work cost savings, CM management reporting, and mobile enhancements allowing nurses on the go to quickly enter activities and notes with a tap of their finger or by voice dictation.
The “Medical Process Manager” fully integrates with the existing claims system to give adjusters and other users a streamlined medical workflow for all documents that come across their desk. Users can take action on documents backed by guidelines and client rules, which they otherwise would not have been able to with the claims system alone.
When elements from two or more of the DataCare modules are integrated, it is easy to see how a more efficient and intuitive system is created. When looking at determinations from the UR Management Reports, certain triggers can be established (programmed?) that immediately tell Adjusters which cases need a Case Manager to aid in the injured worker’s recovery. The adjuster can then instantly share all appropriate medical documents and case history with the new nurse case manager through the Integrated Ahshay platform.
With the implementation of the Ahshay platform, there is no loss in the coordination of care and the patient’s needs are met immediately. However, the process of assigning a nurse case manager and forwarding all the necessary documents can take weeks, resulting in more pain for (the patient) and unnecessary dollars for the payor.
When a request is approved under the Ahshay UR module or by the adjuster using the UR++ feature within the Medical Process Manager (UR++ described in the following paragraph), the service provider is immediately notified without the user having to generate or send any information. The interface gives the provider necessary patient information to directly schedule PT or imaging, and also integrates with One Call / Align for payor convenience. The Ahshay system reduces the coordination of care process so the injured worker can get all necessary treatment ASAP.
DataCare provides a critical tool that fully integrates with the existing claims system and all other DataCare Ahshay modules: The Medical Process Manager. This is a UR++ feature that gives the adjuster a medically-aware, document-driven workflow to aid in the claims handling process. UR++ allows the adjuster to handle requests with client specific rules, along with medical guidelines to indicate whether they are able to approve the request or refer it to UR. If the request can be approved, a determination letter will be generated in one click and sent with all the necessary information and signature. This can be done directly from the Ahshay platform via email or fax. If the request needs further review and needs to be sent to UR, it can be instantaneously shared with another Ahshay client having all documents and claim demographics securely transferred. The request can also be transferred internally to the company’s UR division without preparing any documentation.
By having a fully integrated platform, DataCare saves time where it truly matters most: treatment of the injured worker. All DataCare software solutions can generate reports that pull information from different processes to give a more comprehensive view of the operation and efficiency.
It is important to note: all aspects of the software and integration are backed by a Hipaa SSAE16 type 2 certification.
Start with one module and build up, or try several at once to experience the benefits of being fully integrated.