Atrium’s UM by Exception approach extends across a growing subset of payers: Medicare, some Medicare Advantage plans that have EMR access, select commercial payers, and Medicaid. Other commercial payers have expressed interest in this approach as well and are working with Atrium to make it a reality.
Atrium started with Medicare, then engaged other payers with the process in a data-centered way. If you’re interested in adopting this approach with payers, the first thing you’ll need to do is work internally to analyze your payer trends: denials, approvals, timing, etc. When partnered with XSOLIS, we provide you this analysis as well as offering you an analysis of your cases and claims based on their Care Level Score, helping your organization identify a CLS threshold that covers a significant number of cases with an extremely high level of accuracy on both final billed and paid status.
You’ll then need to work with your UM committee to start the conversation with payer representatives and incorporate XSOLIS into your UM plan. For Medicare cases, the process can be implemented easily and swiftly; for commercial payers, it’s a collaborative process. The value for the payer is clear: their staff is also enduring the same administrative burdens – calls, faxes, denials – and want to find a better way to partner with their providers for a seamless, frictionless approach to managing utilization and providing care for their members.
With the benefits that Atrium has seen from this approach, – around 17% of cases impacted by the smart review process and significant staff time rededicated towards true clinical work – it’s not a surprise that both payers and providers are taking a renewed look at their UM processes. As the the market continues to validate this approach, UM by Exception will be the new normal for utilization management.