Third-Party Administrators
Efficiently manage your services and risk-based agreements to deliver optimal, value-based performance.
Overview
Why Medecision for third-party administrators?
Streamlined utilization management
Shorten turnaround times, reduce pends and appeals, and improve the provider experience through automated prior authorization and AI-powered medical necessity reviews.
Proactive care management
Close care gaps, manage transitions of care, and reduce avoidable ER and inpatient use.
Client-ready reporting
Track key performance & productivity indicators and manage client reporting needs through real-time dashboards and reporting tools.
Simplified compliance and accreditation
Manage evolving federal and state guidelines and maintain audit-readiness through built-in compliance toolkit.
Use Cases
Helping third-party administrators streamline workflows.
Care Management
Strategically identify and engage members with personalized care plans that improve outcomes and reduce avoidable costs.
Utilization Management
Automate prior authorizations and clinical reviews to accelerate decision-making, reduce administrative burden, and ensure appropriate care delivery.
Quality Management
Streamline HEDIS reporting and quality improvement initiatives with integrated data and workflows that boost Star Ratings and regulatory compliance.
Risk Management
Gain real-time visibility into population risk to close care gaps, manage chronic conditions, and align care strategies with financial goals.
Provider Enablement
Empower providers with the tools they need to make informed decisions and enhance patient care with streamlined data interoperability
Patient Engagement
Keep patients actively engaged in their care journey with scalable, digital communications
Case Studies
See how we’ve helped other third-party administrators
HarmonyCare Health Plan
“From day one, Medecision treated us like partners, not just clients. Their implementation team made onboarding smooth and surprisingly fast, and their support team continues to feel like an extension of our own staff.”
Hawaii Medical Service Association
“I’ve enjoyed working with the Medecision team since 2003. They’re very professional, knowledgeable and energetic. They inspire me to go the extra mile, to work harder. We started years ago with utilization management workflow, administration and reporting. By listening to customer feedback, Medecision has a positive impact on healthcare. Its solutions and services continue to help us achieve our vision of building a healthier, happier Hawaii.”
Health Home Partners of Western NY
“We were able to leverage the technology to help us find our patients, evaluate acuity, prioritize and coordinate actions, even when all other services were down.”
Brand New Day
“We’re always looking for ways to make our technology do more, and Medecision is a big help. We were able to configure our system to process authorizations much more easily for all of our Medicare Advantage members. Our physicians flock to Medecision once they learn their members’ risk scores – including pharmacy and lab data – are there and that they can automate their own authorizations. We all like the idea of having everything coordinated in one system. That’s Medecision.”
Data Platform
Our Unified Data Platform is the foundation of our solutions
Unified
data
Harmonize fragmented data into a platform built for healthcare to ensure seamless integration and effortless data management.
Actionable
intelligence
Trigger both human and automated interventions at the right moments to improve quality, reduce administrative burden, and lower medical costs for over 43 million lives.
Event-driven
workflow
Deliver personalized, context-rich workflows by transforming data into real-time insights and eliminating unnecessary administrative tasks through automation.