Use Artificial Intelligence

Payers can see the predicted service-level agreement (SLA) breach scores for prior authorization review requests and the top factors that possibly contribute to SLA breaches on the Prior-Authorization Review SLA Breach Prediction dashboard. They can see services that they are likely to receive from providers and previously submitted services authorization requests for a member on the Recommended Services Pathway dashboard. Providers can see services that they are likely to request on the Recommended Services Bundling dashboard.

• Prior-Authorization Review SLA Breach Predictions
  The Prior-Authorization Review SLA Breach Prediction dashboard shows payers the predicted service-level agreement (SLA) breach scores for prior authorization review requests and the top factors that possibly contribute to the SLA breaches.
• Recommended Services Pathway for Payers
  The Recommended Services Pathway dashboard shows previously submitted services authorization requests for a member and services that payers are likely to receive.
• Recommended Services Bundling for Providers
  The Recommended Services Bundling dashboard shows services that healthcare providers are likely to request.
• Recommended Care Professionals for Patients
  The Service Resource ID field of the Recommended Care Professional records shows the recommended care professionals for patients based on the care professionals’ missed appointment history, treatment frequency for multiple parameters, utilization rates, and average service appointment duration. Use this information to schedule appointments efficiently. Identify care professionals who are best suited for patient needs, and avoid last-minute rescheduling. Maximize patient satisfaction by assigning available care professionals with high effectiveness scores, and avoid discontentment among care professionals by distributing work equitably.