CertSite is an Internet-based service that processes Utilization Management (UM) transactions. These transactions include checking the patient's insurance status (enrollment verification), and giving the OK (precertification) for services such as non-emergency hospital admissions, procedures (such as MRI or endoscopy), or referrals to another healthcare provider (such as a specialist).
2. What is the purpose of Utilization Management?
UM is a useful tool for healthcare payers. It allows them to keep track of what services are being delivered. It also gives them a yardstick to check that the services that are delivered are appropriate for a particular patient. Most payers use carefully developed guidelines that help determine what services are likely to benefit patients in specific situations. If the plan of care for a particular patient falls outside these guidelines, the payer can talk with the healthcare provider to get a better understanding of that patient's situation.
3. How does CertSite help with UM?
Most companies handle their UM transactions over the phone. 
The system works, but it can be labor-intensive and slow. CertSite's concept is simply that most of these UM transactions can be processed much faster and more efficiently over the Internet. By working with healthcare payers, we deliver their network of providers the option of rapid, secure, automatic processing through our web site. The result is faster, more efficient delivery of healthcare and a decrease in administrative overhead costs.
4. Can my doctor or other healthcare provider use CertSite?
Your provider can use CertSite if your payer (insurance company or managed care organization) subscribes to our service. To find out if your payer is on CertSite's network, or if you have other questions, contact CertSite.
