Private insurance utilization management software simplifies compliance

Private Insurance

Netsmart private insurance utilization software helps organizations reduce fraud, waste and abuse. The web-based solution integrates with more than 100 electronic health records (EHR) and electronic visit verification (EVV) apps to aggregate data across providers. As a result, organizations can check compliance with prior authorizations, verify compliance and analyze service delivery without time-consuming manual reporting.

Private insurance claims adjudication technology pre-screens, scrubs and provides all claims submissions in a standard format. The solution shows which claims match and which need additional information prior to payment. Data aggregation and near real-time processing provide commercial health plans with financial insights, as well as the ability to manage utilization of prior authorizations and improve outcomes.



Simplify managing prior authorizations and claims submissions:

  • Web-based solution integrates with over 100 EHRs and EVV apps
  • Supports verification of regulatory compliance and prior authorizations
  • Reduces manual reporting
  • Allows commercial health plans to manage usage of prior authorizations and improve outcomes
  • Allows monitoring of members to ensure compliance for clinical & financial data
  • Highlights clinical data capture to provide oversight to change in condition measures

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