Canopy UM® streamlines the utilization management
process by electronically capturing key patient data and
providing guidance for obtaining the reviews and approvals
necessary to secure authorization and payment of care with
the payor. Canopy UM creates an efficient and effective
denial management program to track claim denials and improve
an organization's success rate for appeals.
Beginning with an HL7 feed from your hospital's system,
Canopy UM guides utilization managers through the process
of capturing and communicating the necessary information
to payors to ensure prompt authorizations and payments.
Canopy UM alerts you when the next review is due, enabling
you to fax the requisite information directly through the
system to your payor contact. Canopy UM enables the hospital's
business office and utilization management department to
work together to identify and track claim denials and to
manage the appeal process. Canopy UM also tracks readmissions,
avoidable days, and adverse events.
Offering a comprehensive
set of features and benefits, Canopy UM facilitates the
utilization management process.
- Provides a real-time hospital HL7 interface that captures
all incoming inpatient, outpatient, and ER encounters.
You now have access to the timely, updated encounter
details necessary for quickly implementing the utilization
review process. This feature also automates the reassignment
of patients to various utilization managers as patients
move throughout the facility.
- Assigns patients to care coordinators based on customizable
rules, such as unit, payor, or physician. This eliminates
the need for manual, paper-intensive systems, while enabling
you to use multiple parameters for patient assignments.
- Flags a readmit for follow-up and monitors the reasons
for readmission. This capability provides statistical
analyses of readmit data for trends and also benchmarks
outcomes for increased efficiency.
- Alerts utilization managers to conduct utilization
reviews and to include essential payor and authorization
information. The automated alerts facilitate timely reviews
of payor status to avoid delays or loss of reimbursable
- Faxes clinical utilization documentation directly to
the payor. You can now focus on clinical, patient-centric
activities, rather than on time-consuming clerical tasks.
- Enables patient-specific communication between the
hospital's utilization management department and business
office to track and recover denials. The resulting partnership
helps hospitals recover denied days and associated payments.
The enhanced communication between the two departments
also ensures the smooth flow of information relating
to continued stay denials and claims denials.
- Tracks and monitors outcomes and variances, including
readmits, adverse events, avoidable days, and variances
from length of stay. You can generate statistical reports
for both real-time and retrospective analysis of critical
metrics. You now have the information you need to quickly
identify and modify parts of the care management process
to more closely reflect "best practices."
- Helps utilization managers refer patients to the appropriate
post-acute services, such as outpatient case and disease
management programs, home health services, and rehabilitation
facilities. This helps maintain the continuum of care
and ensures that patients continue to receive optimal
- Provides fields for documenting intensity of service,
severity of illness, and discharge screening. The ability
to review and evaluate patients' clinical care according
to established criteria enables you to meet the compliance
requirements of external review agencies.
- Provides extensive reporting capabilities, including
tracking and reporting the authorization and denial management
process by payor. Canopy UM includes a standard set of
reports and charts and also works with you to create
customized reports for your organization.