Mckesson signs new customers for auto-authorization and decision
support solution
Newton, mass.--(business wire)--healthfirst, a not-for-profit managed care organization that provides healthcare coverage in new york and new jersey, and providence health plans, part of the five-state providence health & services, a health system providing services to communities across alaska, washington, montana, oregon and california, have licensed mckesson’s clear coverage™ clinical and financial decision-support software with interqual® criteria to automate their authorization and coverage decisions in real time. clear coverage is a powerful prospective utilization management, coverage determination and network compliance platform that ensures automated, consistent and optimal application of health plan coverage, network policy and medical appropriateness criteria in real time, at the point of care. it enables automated medical review, authorization, notification, eligibility and direction of members to in-network service providers, helping payers lower administrative costs and inappropriate medical spend. providers have immediate access to coverage, medical appropriateness and network rules, driving the consistent application of evidence-based medicine. “at healthfirst, we’re always looking for ways to enhance the relationships we have with our providers, and make it easier for them to work with us,” said dr. jay schechtman, healthfirst’s chief medical officer. “by utilizing a web-based interface, clear coverage will enable our providers to submit real-time authorization requests and have them processed in a much quicker fashion. our providers will be able to make more consistent, evidence-based care decisions, which will increase the quality of care our members receive. at the same time, we hope to reduce our administrative costs by as much as 40%.” healthfirst is implementing clear coverage with interqual criteria for imaging and procedures, and will be the first plan to use the product to support inpatient acute and dme coverage decisions at the point of care. providence will use the product to support molecular diagnostics and procedures coverage decisions. to help better monitor utilization, both plans will implement a new feature of clear coverage that automates provider notification to payers about their intention to perform or order a medical service when authorization is not required. along with another new feature that enables transmission of the data needed for manual medical review, automated notification lets users tailor automation with their providers to address the entire spectrum of utilization management from basic communication about services through advanced authorization and retrospective review. healthfirst and providence already use mckesson’s coordinated care management system™ (ccms™) and interqual evidence-based clinical decision support criteria to support internal medical management activity. now with clear coverage, these plans will extend this decision-support framework out to their providers to support shared, real-time coverage decisions and further help to ensure members receive the right medical services at the right time and cost. “by adding clear coverage to an existing suite of mckesson products, healthfirst and providence are initiating a more coordinated approach to care management that will begin to join its existing cm, um and dm silos, drive down medical and administrative costs and improve patient care,” said matthew zubiller, vice president, advanced diagnostics management, mckesson health solutions. “we find that many of our clients are moving on a path towards implementing these and other products to help address gaps in care coordination, eliminate duplicative processes and engage members and providers.” about healthfirst established in 1993, healthfirst is a not-for-profit managed care organization that provides high-quality healthcare coverage to individuals and families living in new york and new jersey. healthfirst offers a variety of government-sponsored health insurance programs, including new york state's child health plus, family health plus, medicaid, and medicare. the healthfirst family of companies includes healthfirst in new york, healthfirst nj in new jersey and hf management services, which provides comprehensive administrative services to healthcare organizations, and senior health partners (shp), a not-for-profit managed long term care plan serving medicaid-eligible clients. for more information, visit the company's websites at www.healthfirstny.org and www.healthfirstnj.org. about providence health plans providence health plans provides health care coverage services to more than 350,000 adults and children in oregon, washington and alaska. providence focuses on improving the health of its members by creating access to high-quality programs and preventive services. providence is recognized for its excellent customer service and its top-rated benefit plans. providence health plans is part of providence health & services, a not-for-profit health system committed to providing a comprehensive array of services to meet the needs of communities across five states, including alaska, washington, montana, oregon and california. about mckesson mckesson corporation, currently ranked 14th on the fortune 500, is a healthcare services and information technology company dedicated to helping its customers deliver high-quality healthcare by reducing costs, streamlining processes, and improving the quality and safety of patient care. over the course of its 178-year history, mckesson has grown by providing pharmaceutical and medical-surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payers; hospital and retail pharmacy automation; and services for manufacturers and payers designed to improve outcomes for patients. for more information, visit http://www.mckesson.com.
