Core Capabilities for Utilization Management
Pre-Service Review Automation
HealOS uses AI to analyze clinical documentation, compare services against coverage criteria, and recommend utilization determinations with clear, evidence-based clinical rationale.
Real-Time Inpatient Monitoring
HealOS continuously monitors inpatient stays and surfaces medical necessity checkpoints in real time as new clinical documentation becomes available.
Post-Service Review Optimization
HealOS identifies improper payments and accelerates peer review by automatically assembling complete evidence packets from claims and clinical records.
Automated Audit & Regulatory Reporting
HealOS generates compliant audit logs and utilization reports automatically to support CMS, NCQA, and state utilization management reporting requirements.
