Utilization Management

Evidenced-Based Care - The right care, in the right setting for the right duration.

 

Better Care, Healthier People and Smarter Spending

Alliant ASO’s 40 plus years of experience as a Utilization Manager and medical review vendor, has garnered us the capability and strategic approach to incorporate principles of clinical leadership, education, analytics, medical policy, and customer service into each of our programs, resulting in positive outcomes on the health of the member population and on customer needs. Our patient-centric and customer-focused UM model includes customizable, standards-based utilization management systems with promotion of clinical best practices. Alliant ASO implements targeted initiatives centered around education and awareness. Our model uses utilization compliance analytics for targeted UM and medical policy recommendations.

Alliant ASO’s primary objective is to provide continuous program improvement through data collection and analysis of service outcomes, program costs, and provider participation.  Our model and approach continues to improves clinical quality, promote member and provider satisfaction, and achieve substantial savings for our customers.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.

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