ezRulesEngine is a rules-based utilization review software solution designed to automate all aspects utilization review. ezRulesEngine includes nationally recognized treatment guidelines such as ODG, ACOEM, various state treatment guidelines and ability to load client specific business rules. ezRulesEngine has been designed to significantly increase the productivity and accuracy of the Utilization Review process with advanced technology. The medical necessity of treatment is validated instantly eliminating the delay of care and recovery to the claimant.
ezRulesEngineTM is a “true rules engine” which can automate various State mandated Treatment Guidelines, Nationally recognized evidence based guidelines and client specific rules. ezRulesEngine offers the ability to employ decisional cascading of rules or guidelines. The guidelines may be organized in a hierarchical order to ensure a thorough appraisal of all UR requests, if a particular service is not recognized by one set of guidelines it would then be evaluated by a second or third set of guidelines.
Key Features:
- Includes state guidelines, MDGuidelines, ODG and ACOEM treatment guidelines
- Full integration of client specific business rules and processes
- Complete certification in minutes to administer treatment
- Can serve as the first level of an extensive multi-level quality assurance process
- State rules and internal guidelines can be housed in a hierarchical order byline
- Reviews are subject to a check and balance and flags reviews that require additional oversight
- Highly configurable to our clients
- Instantly validates medical necessity ensuring proper care of treatment
- Can be fully integrated with any claim application
- Designed to increase the productivity & accuracy of the UR process
- Significant direct and indirect operational savings
- Fully Configurable and transparent Rules to meet your requirements (Add, Edit or modify rules on the fly)
state of the art utilization review and case management tool
Fast & Accurate
Engineered to expedite care and prevent delays. Drive productivity, increase efficiency and create a competitive advantage for your organization. ezRules engine automates the mundane tasks. Instant approvals and appropriate routing to nurses or pa reviews
Platform Independent
Runs on all operating systems. Connects with your utilization review, claims and case management software easily. Use is stand-alone or integrate with your existing software. Easy to implement, requiring less planning and translation across an enterprise.
Real time Rules Management
Manage jurisdictional, business rules and client specific rules through the SME portal. Changes go live instantly. No downtime, no software upgrades
and or installations required. Manage your custom rules online.
Easy to Integrate
Seamless integration with Bill Review, Claims Management and/or UR/CM
Mgmt. systems. Comes with out of box web services, which can be easily integrated with your existing software. EDI ability, data load and download
