MEDecision's online clinical decision support and transaction management solutions are used by managed care organizations (MCOs) to automate the care management process. MEDecision helps MCOs better manage their health care costs and outcomes while reducing their administrative cost expenditures. MEDecision's market-leading products support the care of over 30 million members - approximately one in every seven insured Americans. MEDecision's solutions include integrated case, disease and utilization management; high-risk patient identification; Internet authorizations; provider profiling and quality analysis.
* CarePlanner(tm) is MEDecision’s solution for MCOs seeking to automate their case, disease and utilization management programs. CarePlanner can be implemented on an installed software basis or via an ASP. Both web-based and client/server solutions are available.
* CaseAlert(tm) is MEDecision’s predictive modeling tool that identifies high-risk members before their condition and costs escalate. CaseAlert enables MCOs to improve cost and clinical outcomes by enrolling members in case and disease management programs at a much earlier stage.
* Practice Review System(tm)(PRS), MEDecision’s provider profiling and quality analysis solution, analyzes the quality and cost experience of providers and members. Using integrated clinical logic and rules of best practice, PRS evaluates professional, facility and pharmacy claims data.
* iEXCHANGE(tm), iEXCHANGE is MEDecision's real-time solution that allows providers to submit referrals and authorizations to MCOs for real-time decisions. iEXCHANGE supports web, IVR, and HIPAA standard (278) EDI connectivity.
* MEDInform® 278, MEDecision's EDI product, permits MCOs to accept and respond to HIPAA standard 278 transactions. MEDInform 278 offers the MCO significant administrative cost savings by replacing manual data entry.
* Online Interfaces - MEDecision's online interfaces allow MCOs to use member and provider data from the claims systems and send certification data to the claims system on a real-time basis. Online interfaces provide care managers with real-time data and are available for claims certifications, patient information and provider information.
