Configurable Rules-Based Workflow from Request to Determination
DATA. TOOLS. INTELLIGENCE.
Automated assessment of necessity and eligibility
combined with complete workflows for review,
determination, and post-determination management.
Authorization Requests
VirtualHealth’s provides a complete workflow for both episodic and chronic service authorization requests from inquiry to review to disposition.

Whether used for full cycle authorization management or as part of a multi-system utilization management process, VirtualHealth provides care teams with powerful tools to make timely and accurate care management decisions.
Auto-Approval Rules
Organizations can benefit tremendously from VirtualHealth's embedded auto-approval engine and its extensive library of customizable clinical content.

The platform’s proprietary engine enables both auto-approvals and auto-pends, distinguishes in/outpatient, physical/behavioral, LTSS, and other authorization types, supports rule hierarchies, and provides a uniquely user-friendly interface.
Process Management
From inquiry management and request creation to business rules and clinical review to determination and correspondence, VirtualHealth provides a seamless process for both care team and patient.

By providing organizations with an optimized and rigorous utilization management process, VirtualHealth minimizes inefficiencies, reduces costs, and bolsters care standards.
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Operate with Certainty that the Right Care is
Delivered to the Right Patient at the Right Time