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Utilization Management
Utilization Management
Utilization management is a cutting-edge, customizable utilization and prior authorization management system for health plans.
Why our Utilization Management Solution is preferred by Health Plans
Optimized
Optimized for case and disease management
Flexible architecture
Flexible architecture to meet specific requirements
Real-time updates
Real-time updates and notifications
Identification of Patients
Identification of Patients who need your services at the health plan level
User-friendly interface
User-friendly interface
Reduced turnaround time
Reduced turnaround time
Why our Utilization Management is preferred by Health Plans
Optimized
Optimized for case and disease management
Flexible architecture
Flexible architecture to meet specific requirements
Real-time updates
Real-time updates and notifications
Identification of Patients
Identification of Patients who need your services at the health plan level
User-friendly interface
User-friendly interface
Reduced turnaround time
Reduced turnaround time
Features at a glance
Calypso Lite which is a PCP portal for eligibility verification and authorization submission with real time authorization status updates
Calypso which has approval/denials for part a and part b services, reporting, efficient and streamlined letter batching & letter fulfilment for both members/ providers
Quick AUTH creation while meeting cms/ncqa standards. UM service groups can create commonly used codes for providers with a single mouse click
AUTH Summary which allows end users to complete a quality check
USER QUEUE’S with each queue having a summary tab with specific information to ensure timeliness
SMART ASSIGN which helps intake coordinators identify the work volume in each referral coordinator, nurse, or md queue
In accordance with CMS/NCQA standards, members receive approval/denial letters via USPS. Fax notification is also provided on all requests
○Part B: Approval, Denial, Pending, Rescind, QIO NMNC, Global CMS Audit reports: Expedited Organization Determination (EOD) and Standard Organization Determination (SOD) Universe, EOD and SOD Universe Internal, CMS, Timelines, Timelines, Internal.
○PART A WORKFLOW: Intake queue, Nurse review queue, MD review queue, MD peer to peer queue, Facility queue, Prior auth coordinator queue, Discharge planning queue, QC approval (letter batching), QC denial (letter batching)
* Intake approval has restrictions for specific services to ensure medical necessity review by a licensed clinician.
BACKEND SERVICES:
○API’S to receive information from Provider Villa, Member House, MDM.
○278 EDI transactions
○API’S to provide information to the following system’s:
○Claims adjudication
○Customer service management
○Provider Portal
REPORTING:
○Standard reports:
○Part A: Approval, Denial, Pending, Rescind, QIO NMNC, Global, Overdue, Inpatient census, Key metrics, Discharge
○Part B: Approval, Denial, Pending, Rescind, QIO NMNC, Global
CMS Audit reports: EOD Universe, SOD Universe, EOD Universe Internal, SOD Universe Internal, CMS, Timeliness, Timeliness, Internal
DASHBOARDS:
○Part A: To measure productivity and member LOS at a glance.
○Part B: shows TAT to ensure CMS timeliness standards/ internal timelines are being met. Also shows how the requests were received and how many standard vs expedited requests.
Download BrochureWhy choose MIRRA's® Utilization Management?
We understand that Members and Providers require a solution that solves the time crunch and work seamlessly with their existing system to get the authorization requests processed on time.
Ideal for managed care, our Utilization Management modules can easily integrate with your organization’s management system and fix the bottlenecks in no time. Calypso, our range of software, is streamlined to take only 2 minutes to enter an authorization request into the portal.
Reviews & Testimonials
Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline.
We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."
NANCY GAREAUCEO of Ultimate Health Plans
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