Our utilization management solution provides a means to ensure appropriate use and setting of services that health insurers (payers) find indispensable. We offer several different methods of utilization control that examine medical necessity and appropriateness for the level of service and are meant to safeguard against unnecessary utilization of care and services. We work with our customers to align their programs.
Using Alliant's Web-based utilization management tool-Quantum XL™-for service authorizations, we are able to provide assistance in appropriate allocation of resources by:
- Helping with fiduciary responsibilities
- Provide prior authorization reviews
- Produce retrospective reviews and data analysis
- Provide real-time reviews
- Identify candidates for more intensive medical management
Not only does Quantum XL streamline the utilization management process, it reduces the administrative burden on providers, freeing up time that can go back to the practice of medicine.
The impact of utilization of a prior authorization requirement for certain procedures is the foundation for making appropriate policy decisions, as well as capturing wasted time, eliminating unnecessary procedures, and saving money.
We provide a comprehensive, integrated platform of quality improvement tools and methodologies to help streamline workflow processes, pinpoint critical problems, and accelerate the rate of quality improvement of health care delivery. They include:
- Focused Quality Studies
- Training and Education
- Program Development
- Program Evaluation
- Quality Assurance
- Provider Academic Detailing
Our experienced staff knows the health care environment and how to drive real-world change through project leadership. Past projects have included
- Electronic Medical Records
- Health Disparities
- Payment Error Rates
- Diagnosis-Related Groups (DRG)
- Appropriate Care Measures
- Medicare Part D (Pharmacy)
- Care Transitions and Re-admissions
- Acute Care Hospitalization
- Patient Safety Programs
- Infection Control/Prevention, e.g. MRSA
- Adverse Drug Events
- Prescription Drug Abuse
- Wellness Campaigns
- Acute Myocardial Infarction
- Chronic Kidney Disease
- Congestive Heart Failure
- Community Acquired Pneumonia
- Breast Cancer
- Smoking Cessation
- Atrial Fibrillation and Stroke
- Carotid Endarterectomy
- Pressure Ulcers
MedGuard™ is the Alliant ASO system of integrated software applications and services that provides health plan integrity functions to identify, recover, and prevent inappropriate payments for health care. These functions include detecting, investigating, and preventing fraud, waste, and abuse by health plan participants. With MedGuard™, we are able to analyze claims and payment data using statistical and database techniques that look for patterns to suggest fraud or abuse. MedGuard doesn't rely solely on formulas to determine fraud, but uses a unique combination of software and experienced judgment from informed clinician/auditors. With Alliant ASO's MedGuard, you never have to wonder if an honest mistake is costing you money or if you have an integrity problem. We can, quickly and confidentially, provide you with the accurate information you need to make smart, operational decisions.
When an external review is needed to resolve a dispute or clarify a medical issue with an insurance company, you can rely on our proven-successful integrated approach to help you determine process capability and reduce waste for your business. Our role in conducting medical reviews for services across the continuum of care is to determine medical necessity and appropriateness of clinical setting. To do that, we utilize our clinical expert panel of over 330 clinical specialists in over 60 clinical specialty areas. Alliant ASO has a successful 35-year history of providing medical peer review services for the State of Georgia. Alliant ASO's independent review services are always custom-tailored to meet your organization's needs. Whatever your review case needs, you'll find Alliant's dedicated and experienced staff will be able to capably address it with sensitivity, integrity and dependability.