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Mitchell Launches Next-Gen Automated Solution That Integrates Medic al Bill Review and Utilization Review

SmartAdvisor Utilization Review Decision Manager seamlessly integrates medical bill review and utilization review to deliver more accurate workers' compensation medical bill pricing adjustments, according to Mitchell International.

Mitchell International (San Diego) has launched SmartAdvisor Utilization Review Decision Manager, which the vendor describes as its next-generation medical bill review application that seamlessly integrates medical bill review and utilization review (UR) to deliver more accurate workers' compensation medical bill pricing adjustments. The solution provides clients the flexibility to apply a variety of state-mandated and nationally accepted guidelines as well as acting as a tool to implement their own custom UR guidelines and treatment plans, according to a Mitchell news release.

The Mitchell SmartAdvisor UR Decision Manager addresses a major source of financial leakage in the medical claims environment which occurs when there is inconsistent application of utilization review or treatment plan decisions within the bill review process, according to the vendor.' The flexibility, control, and accuracy that the SmartAdvisor UR Decision Manager offers will result in a vastly more efficient claims process that produces greater straight-through utilization review decisions, reduced staffing requirements, and ensuring that only approved treatment is allowed in the bill review process, Mitchell asserts. The solution is powered by the Capstone Business Decision Engine, a fully configurable business rules engine from SmartAdvisor that automates bill review and repricing decisions. The next generation SmartAdvisor UR Decision Manager will be available in July 2010.

"With SmartAdvisor UR Decision Manager, we are adding to our suite of flexible, highly configurable medical bill review tools in order to respond to a clear and compelling business need for automating and seamlessly integrating the application of utilization review within the bill review process," comments Nina Smith, senior vice president and general manager, Mitchell International SmartAdvisor Solutions. "It's common knowledge in the industry that unenforced medical utilization determinations create significant financial leakage in the claims operations."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio

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