Utilization Management

We pair our URAC-accredited processes with our proprietary system, Quantum XL, to provide a consistent and efficient approach to comprehensive utilization management. By integrating clinical criteria and our customers’ policies, Quantum XL provides one location for all review work and:

• Helps with fiduciary responsibilities
• Streamlines the review process
• Provides prior authorization reviews
• Produces retrospective reviews and data analysis
• Performs real-time and automated reviews
• Identifies candidates for more intensive medical management
• Reduces the administrative burden on providers

Case Study

In a case study of Quantum XL™ implemented for selected radiology procedures, our client was able to see that the prior authorization requirement substantially reduced numbers of claims for radiology procedures and resulted in a projected cost difference of $30.2 million over a 17-month period. Alliant | GMCF provided the services and the information needed to effectively administer the programs.