Providers are overwhelmed with hospital utilization management and prior authorization documentation requirements with the volume of reviews. While the EHR holds a wealth of information, it requires the utilization manager to go digging to find the relevant information necessary to determine the appropriate level of care as well as gathering relevant clinical context to be shared with the payer.
One of MCG’s solutions connects structured patient data to our gold standard evidence-base care guidelines to improve the medical necessity review process and help utilization management staff determine appropriate patient status. However, relevant information for reviewers is often found in unstructured notes data.
In this session, we discuss MCG’s approach in surfacing relevant unstructured patient data to improve the efficiency and effectiveness of medical necessity documentation using Spark NLP for Healthcare.