Quality management starts with setting quantifiable goals. The MedGrail quality supports unlimited number of goals associated with its members. Gathering the quality information is managed through the workflow and individual reviewers fill the forms that may be either constructed from standard pieces (questions) or loaded from a pre-established templates.
Personal information including demographics, payers and full identification. When integrated with the membership system, the UR provides full access to the current member eligibility. The inclusion and eligibility issues are available for the reviewer and the system provides a number of warnings to the operator.
Provider searches with direct controlled access to a patients record. The providers may be located / loaded into the current database, or imported from the external claim system (subject to integrator settings). The application supports wide range of workflow requirements.
Concise forms allow the reviewer to use minimal number of forms to accomplish the task. The form use standard HTML to present information in clear easy to read formats. The forms adjust their content and appearance depending on content or user selections.
Built in workflow system ensures that all cases are followed on consistent basis. Management portal includes ability to balance workload of individual reviewers and to access management reports. A user logs on a specialized portal that defines both the list of available forms as well as what subset of functionality to use.
Integration with the claim / authorization system is supported when technically feasible. The application is designed to communicate directly with the external claim / authorization database and the integration may require expansion of our integration module.
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