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Gain clarity and efficiency.  Reduce Denials and Cost.  

 

We specialize in simplifying your referral and prior authorization workflow, ensuring a clearer view of your processes, reducing denials, and minimizing manual work.  

VTS’s intelligent automation platform uses our unique engine and algorithm, artificial intelligence, and RPA to automate the insurance verification, normalization, referral submission, prior authorization and statusing.     

Mountain

HOW VTS WORKS

Empower your operations with Clarity and Efficiency

01

ELIGIBILITY VERIFICATION & REVIEWS

Automated Eligibility Reviews

 

VTS automatically reviews eligibility responses from insurers and immediately notifies or alerts the relevant staff for review, ensuring no patient's coverage goes unchecked.

Error Correction

 

With advanced algorithms, VTS auto-corrects common errors in Medicare Managed Care Allocation and Third Party Liability, reducing manual workload and minimizing claim denials.

03

REFERRAL SUBMISSION

PCP Referrals

 

For primary care providers (PCP) within the healthcare system, VTS automates the submission of referrals, streamlining patient routing for specialized care.

External PCP Requests

 

 If the PCP is outside the system, VTS automatically sends referral requests to the physician, ensuring continuity of care.

Referral Status Checks

 

Directly communicates with payers to check the status of referrals, integrating results into the workflow for seamless operation.

02

INSURANCE NORMALIZATION

Historical Data Analysis

 

Our solution discovers a patient’s active insurance plan from historical data, ensuring billing is directed to the correct insurer.

 

Insurance Change Detection

 

VTS auto-detects any insurance changes or inconsistencies, automatically correcting them to prevent billing issues and claim rejections.

04

PRIOR AUTHORIZATION

Automated Requests:

 

Sends authorization requests directly to payers, including clinicals, without manual intervention, speeding up the approval process for patient care.

 

Authorization Tracking

 

Continuously checks the status of authorization requests and integrates the findings into the healthcare workflow, ensuring timely patient service.

 

Comprehensive Coverage

 

VTS covers all healthcare service lines, including ambulatory, ER, in-patient, ancillary, observation, transitional care, and more, covering aspects of patient care.

 

Notification of Admission (NOA) and VA ER Authorization

Automatically sends NOA to payers and VA ER Authorization requests to the VA, facilitating urgent care and compliance with regulations.

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