Flexible activity reports simplify claims processing and data sharing

Clinix Healthcare’s proprietary access-based clinical management technology enables us to help you meet your data needs and reporting requirements. We assist with clinical management, client reporting and state and regulatory reporting requirements. And we can analyze your claims data to identify members with a specific diagnosis.

Informational activity reports are available in all media forms to support your needs. Clinix can email, fax or provide hard copies of reports. Our staff enters precertification and negotiation results directly into your system, or provides an electronic file for downloading.

We encourage your feedback to continuously improve our reports’ content. To date, clients’ suggestions have been implemented at no additional cost.

Utilization Review

Clinix provides our standard Final Status Report, identifying the total number of certified days, dates of service and demographic information regarding the location and provider of services.

Our nurse reviewers alert payers about potentially high-cost claims and those potentially related to workers’ compensation, secondary payers and subrogation.

Case Management

Clinix provides standard Initial Assessment Reports, Interim Status and Final Status Reports. Each report summarizes the clinical assessment and current status of the member. It also indicates healthcare services, educational needs, cost savings impact and intensity and duration of planned services.

We provide an initial clinical assessment within 30 days of referral. It’s based on contact with the provider and patient. Interim reports are provided monthly, and a final report when the case is closed. These reports include a clinical summary, current clinical status and services required or that will be required, the cost of services and anticipated treatment length. Each report includes costs and savings for services.

Disease Management

Clinix provides a monthly listing of participating members in the Wellness Education programs. At predetermined intervals, we provide population-based functional and clinical status reports indicating the aggregate status of participating members.

Initial and final functional and clinical status comparison is made after members have completed the 18-month program.

Medical Claims Review

Clinix provides a short report at the closure of each case reviewed to support the claims payment process. Each report states the medical necessity decision and the clinical rationale for it. MCR completes reviews within 5 business days provided that additional clinical information is not requested.

Reinsurer Alerts

Clinix notifies designated reinsurers at the same time as our clients about potentially high-dollar claims. We provide interim reinsurer weekly case listings and annual information reports to ease renewals. We summarize extensive individual case management reports into one report per individual.

Client Activity Reports

Clinix provides a monthly clinical summary of inpatient, outpatient, case management and disease management. It’s provided to the payer within 4 business days of the current month ending. It’s intended to provide a quick reference for all programs accessed by the members.

Learn how Clinix helps companies like yours manage employees’ healthcare benefits.

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