Utilization Review Software

DataCare understands the challenges you face in healthcare administration. That’s why we created AHSHAY!, a utilization review software designed to simplify your decision-making process. AHSHAY! ensures you stay compliant and efficient, allowing you to focus more on patient care and less on paperwork.

Simplifying the Documentation Process

When looking for utilization review software, you need one that efficiently manages the comprehensive documentation required in healthcare. AHSHAY! is designed to help streamline these processes, providing features that facilitate quick access to medical histories, treatment plans, and insurance information in a unified system. This centralization helps reduce the time you spend managing documents, allowing for more informed and timely decision-making.

Additionally, this preauthorization review software supports compliance with regional and national standards by regularly updating and incorporating the latest regulatory requirements into your workflow. This integration helps alleviate concerns about keeping up with new regulations that can impact patient care management. By simplifying compliance and documentation tasks, AHSHAY! enables you to focus more on delivering quality patient care while minimizing the administrative overhead.

Utilization Review
Preauthorization Applications

  • Utilization Review in the workers’ compensation industry

  • Hospital systems that provide Utilization Review services
  • Self-insured employers who staff their own Utilization Review employees
  • Third-party administrators who employ their own Utilization Review staff
  • Assisted living facilities that provide Utilization Review services
  • Utilization Review in the healthcare industry

What AHSHAY! Can Do For You

  • Proactive Time Management

    Stay on top of deadlines with alerts for upcoming due dates and efficiently track how quickly cases are processed. Our tool’s electronic workplace offers seamless integration with DataCare programs or functions as a robust standalone system.

  • Streamlined Compliance & Workflow Integration

    Automatically integrate medical guidelines and jurisdictional rules into your workflow to ensure compliance and streamline decision-making. Utilize evidence-based guidelines that support CPT treatment codes seamlessly within your processes.

  • Automated Documentation & Cost-Savings Reporting

    Generate and store state-specific templates and letters directly in the system, maintaining compliance easily. Track real-time savings based on state fee schedules for denied requests, optimizing financial outcomes.

  • Enhanced Visibility & Seamless Integration

    Monitor medical histories, document case turnaround times, and manage referrals with ease. The system supports the generation and direct sending of physician letters to improve communication. It also integrates effectively with claims, bill review, and internal client systems for real-time data exchange. Additionally, you can access all features on any device, ensuring functionality and oversight wherever you are, backed by a SOC 2 HIPAA-compliant network.

  • Advanced Analytics & Customization

    Access advanced analytics through the UR++ module for an even more automated version of utilization review, enabling deeper insights and greater customization.

End-to-End Case Management Solutions

Within the workers’ compensation industry, where data security is paramount, especially for HIPAA-protected information regarding patients and injured workers, DataCare’s AHSHAY! Utilization Review Software prioritizes the highest security standards. Its SOC 2 Certification demonstrates its commitment to secure, reliable, and confidential data handling practices, ensuring complete peace of mind for your organization.

As a SOC 2 Certified Platform, AHSHAY! features:

  • Robust Security Protocols. Adhere to the highest security standards, ensuring that all patient and worker information is protected effectively.
  • Guaranteed System Availability. Bank on dependable system performance, ensuring continuous access when you need it most.
  • Assured Processing Integrity. Trust in the accuracy and completeness of your data processing, from entry to report.
  • Enhanced Confidentiality. Expect the highest confidentiality standards, guaranteeing that sensitive data is always safeguarded.

Choosing our utilization review software provides more than just a solution. It offers peace of mind, knowing that security is a cornerstone of our software. This prevents your company from being prematurely excluded in the bidding process, allowing you to focus on delivering core services without the overhead of managing compliance and security measures.

Many healthcare service organizations often rely on a patchwork of disparate systems for managing preauthorization reviews. This approach often leads to inefficiencies, data silos, and potential security vulnerabilities. DataCare’s AHSHAY! Utilization Review Software eliminates the need for such complex integrations, providing a unified platform that streamlines workflows and ensures compliance with SOC 2 standards. This strategic approach allows your company to leverage our advanced technology and expertise without the burden of managing multiple systems and the associated security risks.

Spend more time where it counts – with the patient! Request a Demo today.

Success Stories

Ahshay! and its various case management software modules have proven to improve the effectiveness and efficiency for our clients. Here are just a few examples:

Michele Settel, President of Ascential Care Partners, emphasized, “DataCare really understands the case management and utilization review ecosystem. Their platform is robust and stable, a must-have in a systems provider. Our focus at Ascential Partners is to promote the right treatment so our patients get back to their lives using the most expedient, cost-effective, and solution-minded way. DataCare is an important partner, helping us with our mission.”

A Risk Management Supervisor said “The Datacare team is wonderful to work with and is always responsive! They continue to improve the software as well as their caliber of staff. Datacare is the best company I have worked with in a capacity of vendor because they truly care about the quality of their product and service! I would recommend Datacare to anyone looking for claims/bill review software.” 

Thomas Kokkines, Vice President of Optimal Case Management, stated, “The reporting offered through Ahshay!, along with the evidence-based data that ODG provides, allows us to paint a clear picture to our clients on how our nurses are positively impacting return-to-work results. The information captured in Ahshay! allows us to analyze various data elements that can be useful to not just our clients, but our nurses and management.”

Sean Mullen, Senior Management Analyst, Santa Clara County, said, “Just to put this in dollars and cents, at County of Santa Clara, we experienced over $600,000 additional savings based on this new utilization review platform. That’s over $600,000 beyond what we had experienced the year before, without this automated utilization review, bill review platform.”

Discover the wide range of applications you can do with AHSHAY!

Healthcare Case Management

Designed for healthcare professionals, AHSHAY! is a Nurse Case Management software that simplifies and enhances the workflow. With its customizable reports, accessible from any location, this software empowers professionals to prioritize patient care and alleviate administrative tasks, streamlining their processes and improving overall efficiency.

Beyond this, AHSHAY! also functions as a Workers Comp and Automotive Case Management software.

Medical Process Management

AHSHAY! is a Medical Process Manager (MPM). It’s a user-friendly tool designed to assist adjusters in managing the medical review process. By streamlining approvals, integrating guidelines, and ensuring compliance, AHSHAY! effectively lightens the workload and elevates the efficiency of medical claims processing.

Utilization / Preauthorization Review

DataCare’s AHSHAY! platform includes a Utilization Review/Preauthorization Software. This module streamlines healthcare workflows by expediting decisions, minimizing redundancies, and ensuring compliance. It directly integrates guidelines, automates tracking, and generates audit-ready reports.
Furthermore, the platform incorporates tracking automation and bill review, enhancing the management of medical processes.

AI Document Assistant (Coming soon)

Utilizing AI, our AI Document Assistant module efficiently organizes, sorts, and retrieves documents. It intelligently categorizes documents based on content, seamlessly integrating them into relevant case management workflows. This module reduces the need for manual review, streamlining document handling, and improving overall efficiency.