aCodec Utilization Management

The ability of MLTSS health plans to produce accurate and timely cost and utilization data is a critical practice in a health plans ability to manage its own operations. It is also necessary for the State to receive accurate and timely information, which is used to establish sound capitation rates; monitor the financial viability of health plans and assess quality of services being provided to members.

aCodec Utilization Management dashboard and reports offer insights into utilization metrics incorporating functional status, cognitive status, diseases, population specific criteria, and services. MLTSS Organizations can utilize aCodec Utilization Management data to prioritize intervention strategies that are specific to their population and implement targeted Care Management and Disease Management programs for reducing unmanaged costs and improving outcomes.

aCodec Utilization Management leverages intelligent business rules for uncovering gaps in services and identifying overutilization of services from the following data:

  • interRAI Assessment Data
  • interRAI Scales
  • Personal Care Assistant Nursing Assessment Tool
  • EMR
  • Claims
Utilization Management Report Highlights
  • Analyze appropriateness of services based on functional status, cognitive status, and population specific criteria.
  • Enable deeper insights for better utilization management. Provide a comprehensive approach to uncovering gaps in services, reduce unnecessary services, cut spending associated with overutilization, and improves coordination of care for better healthcare outcomes.
  • Analyze year to year utilization of service at the organization, provider, and member level.