Alineo Automated Approvals enables healthcare payers to create
rules that automatically evaluate requests for service (referrals,
authorizations, extensions, etc.) submitted through Alineo. It is a
comprehensive and flexible tool with which payers can apply
consistent decision making processes to transactions regardless of
where they initiate. This minimizes the need for human intervention
and manual administration, which helps to streamline transactional
workflows. In addition, since it can be extended to physicians
through InFrame™ iEXCHANGE or individual provider
portals, Alineo Automated Approvals facilitates greater messaging
and clinical consistency.
Alineo Automated Approvals is embedded with clinical criteria
that establish pre-existing clinical rules. However, one of its
primary features is an inherent flexibility that enables payers to
create customized rules according to various clinical and
organizational needs to determine the result of a request. Possible
results include:
- Auto-Approve
- Pend
- Pend With Message: Alerts the user that the request can be
approved if the number of units, visits or days requested is
modified. Otherwise, the request will pend.
- Ask Additional Authorization Questions: Allows the user to
answer additional questions that may impact the result of the
request. Questions are created by the payer in the Alineo
questionnaire module.
Payers also have the ability in Alineo Automated Approvals to
create custom messages associated with auto-approval rules. This
enables organizations to further enhance automation by educating
providers as part of the request submission process.