Pre-certifications & Authorizations

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Specialist Referrals and In-Patient Authorizations can be integrated with benefit determination and can be managed directly with the system or accepted via external resources using standard or proprietary interfaces. When managing authorizations, the system can allow you to be very succinct in your identification of approved providers and specific services, or you can offer relaxed authorization rules that would be more forgiving in regard to matching to provider or services. No claim processing system is complete without the ability to capture, monitor and track episodes of patient care. Care management functions within VISOVA are event driven and make certain claim payments are accurate.

Use VISOVA’s flexible event system to manage care and interact with claim payment.

  • Pre-certifications
  • Authorizations
  • Referrals
  • Large Case
  • Auto-Detected conditions
  • Subrogation
  • Correspondence tracking
  • Workman’s Compensation
  • Utilization and Review
  • Grievance and Appeals
  • Member Services
  • Legal
  • Garnishment
  • Short Term Disability Payment Management
  • Healthy Plan participation with clinical tracking