Bedford, MA (PRWEB) June 10, 2011
Casenet, LLC, a leading provider of innovative healthcare management software products, today announced its release of TruCare 4.5. Release 4.5 builds on the foundation of TruCare's state-of-the-art functional architecture, to deliver increased authorization and claims payment accuracy, reduced Medicaid fraud and abuse, and enhanced Pervasive Population Management. This new TruCare release culls data from 140 key metrics to feed into its newest core module - Opportunity Identification.
Real-Time Authorization Web Services
The Real Time Authorization Outbound Interface (RTAOI) is available as an alternative to Casenet's high-speed 278 batch processing for outbound authorizations. The RTAOI allows for authorizations entered into TruCare to be sent real-time to the customer’s administrative system, including each line-Item request, for immediate validation. In turn, the TruCare Web service supports a real-time response from the administrative system, which enables the TruCare user to view the administrative system’s authorization status while simultaneously processing the authorization in the TruCare Utilization Management subsystem.
This very sophisticated two-way real-time web service has been developed so that the administrative system interaction is generic and extensible, which enables it to operate with any administrative system.
Enhanced Medicaid and Dual Eligible Transportation Capabilities
TruCare Release 4.5’s transportation functionality assists Medicaid plans with tracking the transportation benefit— a benefit vulnerable to overuse or even fraud. TruCare enables a user to request, authorize, review, and monitor member requests for transportation services. This subsystem includes a flexible and easy-to-use recurring transportation authorization function, and a batch-process invoicing feature, which in turn allow more simplified billing for a plan’s transportation vendors.
A standard set of 140 key metrics is provided in TruCare Release 4.5 with optimal ranges, filters, and units, to configure as appropriate. TruCare allows clinical users to record, view, and trend a member's laboratory results, immunizations, vital signs, and other clinical data. Release 4.5 performs automatic unit conversion and graphical displays of key metric data. In addition, all standard key metrics can be identified specifically as HEDIS measures for a member.
TruCare’s Opportunity Identification functionality analyzes the broad spectrum of member data contained in the system, including:
- Predictive Modeling
- Member Demographics
- Utilization Management/Claims
- Case and Disease
Release 4.5 features high-volume and high-speed data “crawlers” that mine large member populations and search for opportunities and gaps in care. These crawlers use highly flexible and configurable parameter-driven processes. Crawlers can be initiated in batch and real-time for data analysis.
Opportunity Identification will initiate individual (Task) or group (Queue) actions within TruCare. Opportunity Identification is fully integrated with TruCare’s Differential Care Management (DCM) functional architecture foundation. This enables the creation of Opportunity Identification System parameters for specific segmented member populations, which correspondingly enhances data analysis and the resulting actions that are targeted to those populations.
Casenet CEO Kevin Brown stated that “Casenet’s ongoing commitment to deliver solutions that impact the three key focus areas of all care management organizations—improving clinical outcomes, increasing operational efficiency, and reducing costs—are reflected in the breadth of new functionality delivered in TruCare 4.5. Our existing clients who manage a combination of commercial, Medicare, and Medicaid members will immediately benefit from these significant additions to TruCare.”
About Casenet, LLC
Casenet provides a comprehensive suite of member-centered care management software and service solutions, including Case Management, Disease Management, Utilization Management, Health and Wellness, TruMobile, Total Population Management, Provider Portal, and Operational Reporting that enable organizations to align to their unique requirements and to adapt quickly to changing market and regulatory dynamics. At the heart of the system is a highly client-configurable foundation called Differential Care Management (DCM). DCM enables organizations to isolate and target populations having unique risk characteristics and to deliver specific care management programs for those members.