Question: I'm looking for a utilization review tool that automates decision-making and ensures compliance with medical guidelines.

If you need a utilization review tool that automates decision-making and ensures medical guidelines are followed, Cohere Health is worth a look. Its Cohere Unify platform is designed to modernize prior authorization in healthcare, making it more efficient, accurate and patient-centric. It offers features like automated prior authorization decision-making, AI-assisted manual review and queue management that can cut administrative costs and denial rates while improving care quality and outcomes.

Another contender is DataCare, which offers a range of healthcare management software including tools for case management, utilization review and workers' compensation. DataCare has a focus on security and compliance, offering HIPAA-compliant and SOC 2-certified solutions. The software automates administrative tasks, improves patient care and boosts operational efficiency, and is a good option for healthcare organizations looking to improve their operations.

If you're looking for a platform that integrates with electronic health records (EHRs) and uses AI to optimize operations, check out Qventus. The healthcare operations platform uses AI and machine learning to optimize patient flow and operations. By automating tasks like phone calls, document processing and image processing, Qventus can help reduce manual work and improve operational efficiency in hospitals, health systems and medical groups.

Also worth considering is UpToDate, a clinical decision support system with evidence-based answers. It offers expert editorial content continuously updated by a team of more than 7,400 clinician editors and can be accessed through EHRs, mobile devices and other interfaces. UpToDate's trusted content helps healthcare professionals make decisions, improve health outcomes and provide better patient care.