Statewide Investigation Due to Critical Error by Insurance Giant

Ensure your company is protected with the right software! // Aetna, the nation’s third-largest insurance provider with 23.1 million customers, is under fire from an investigation led by the California Insurance Commissioner, Dave Jones. While Group Health is already a stringent practice that requires adherence to several laws and regulations, one of Aetna’s reviewing physicians [...]

Are You Prepared For Senate Bill 1160?

This letter is to address the impact of Senate Bill 1160 (or SB1160) pertaining to self-insureds, TPA’s or third-party-administrators, employers, and utilization review organizations across California. On September 30, 2016, SB1160 was signed by Governor Jerry Brown, which is set for implementation beginning the first of January in 2018. The result of this bill will [...]

Drug Formulary: Quick and Easy Approvals with UR++

Express authorizations can be performed faster and more easily with the use of drug formularies. The recent release of the California Drug Formulary uses a very objective language suitable for fully- or partially-automated approval of requests. For example, after entering a medication request in DataCare’s UR++ system, the system can easily determine if the request should [...]

UR++ 1.4 for Adjusters and Claims Professionals

DataCare is proud to present its latest release for Adjusters and Claims Professionals: UR++ 1.4 WHAT'S NEW Adjusters/ Claims Professionals come across several Request for Authorizations (RFAs) each day, and some cases may require additional attention. For this reason, the latest version of UR++ enables clients to incorporate a best practices ruleset to make approvals [...]

Benefits of Integrating CM, UR and Adjuster Software Modules

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 [...]

Cutting Complexity in Workers’ Compensation Utilization Review Programs

DataCare UR++ reduces utilization review program costs by enabling claims adjusters and trained administrators to routinely approve 80% or more of all treatment requests and by significantly reducing the number of referrals to more expensive nurse or physician reviews. Quick approvals also shorten the time it takes for employees to return to work. With Express Approval: [...]