Telligen is excited to announce its latest update on enhancements made to our latest Qualitrac release (2024.01). Our clinical and technical experts work year-round to enhance and advance the product, which is how we’re able to help our clients achieve their goals for quality and outcomes improvement, and cost savings.
Utilization Management Enhancements
Auto Authorization Business Rule Updates – Telligen has enhanced Qualitrac’s Business Rules Engine to now include configurable auto-approval rules for Dental, Inpatient Hospitalization and Inpatient Psych on Utilization Management (UM) cases. These rules define a specific workflow that will trigger a status change from ‘Outcome’ to “Auto Approved” when all of the conditions have been met. Through the use of these rules, providers experience real-time updates, giving them quicker turnaround times.
Transmission APIs – Development of new API interfaces to transmit the outcomes of Utilization Management reviews to the payer system. This new development provides clients with flexibility in choosing the method for the transmitting of outcomes and frequency, as the Qualitrac system can support API calls on a case-by-case basis or providing batch file processing.
Additional Reason Codes – New client preference that allows UM reviewers to select multiple reasons or reason codes for supporting their review determination. These reasons and reason codes are then included in the outcome letter provided to the requestor and other appropriate parties as supporting rationale for the review outcome.
Claims API View – Development of a new API interface to connect with claims payment systems and provide a view of the member’s claim history within the Qualitrac application. This claims view assists reviewers with understanding the claims that have been processed already for a member to ensure they do not approve more than is allotted as well as provide Health Coaches and Care Mangers a view into the member’s medical history. Users can view a full history of all claims or search for a specific claim.
Case Management Enhancements
Device Syncing – New functionality in our mobile app that allows users to choose from an extensive list of compatible devices and applications to sync with our mobile app. This functionality reduces the burden of manual data entry for users and helps to ensure all activities get logged.
Exercise Logging – New exercise logging feature added to our mobile app that allows users to track and log a variety of different types of exercises and their supporting details. Exercise activities that are logged by the user are also viewable for the Health Coach or Care Manager that is working with the member to help support them in their Health and Care Management journey. The exercise logging feature also includes easy to read visual charting so that members can view their exercising trends and progress.
Assessment Management Enhancements
New Reports Landing Page – New accessible design to the reports landing page. In addition to user interface (UI) enhancements, new functionality includes the ability to search for reports, filter reports listed by category, view a description of each report, and mark reports as favorites. With these enhancements, users can access the reports they are most interested in quickly and efficiently.