CertSite contracts with healthcare payers and third party administrators (TPAs) to automate and process Utilization Management (UM) transactions. We can handle eligibility verification, referrals, and precertification of hospital admissions and outpatient procedures. Our business is to allow your network of providers the option of processing the same UM transactions that currently are being submitted over telephone, fax, or EDI more rapidly, more efficiently, and less expensively over the Internet.
2. What will CertSite do for you?
First and foremost, CertSite decreases UM costs. 
CertSite's member-per-month fee is substantially less than large Managed Care Organizations' expense for Utilization Management (PEER Administrative Expense Benchmarking Study, Sherlock Company, 1999). We won't completely replace your UM department; providers who lack Internet access will have to rely on traditional channels, and cases that require medical review will be directed to your existing UM staff. 
But we will be able to significantly decrease the volume of calls your UM department has to field: 90% or more of UM requests can be handled by our automated system, and that translates into savings for you.
3. So we save money. What else?
CertSite delivers happy providers. According to an article in the August 9, 1999 issue of Modern Healthcare, staff in physicians' offices frequently spend over two hours' processing time per referral. With secure access to our web site, referrals can be done in 10 minutes. Precertifications by the traditional routes can take even longer; CertSite's processing time is under 15 minutes. 
Eligibility data is available online, can be checked immediately, and is current daily.
All this adds up to providers that can devote more of their resources to patient care and less to administration, providers who breathe a sigh of relief when the patient who walks in their door is covered under your health plan.
4. Better budget, happy providers. Keep talking.
How about happy members - ones who walk out of their PCP's office with the procedure or referral already scheduled, rather than going home to wait for a call?
How about providers that can submit and process their UM transactions any time of any day? If they have evening or weekend clinic hours, requests don't have to wait for the next business day.
Where does your utilization data go? Can you track utilization by provider, patient, service, clinical data in real time? CertSite's database allows you to retrieve and examine your UM transaction data in the format that serves you best.
5. But my system is older than HAL. What kind of upgrade am I going to need to get onto CertSite?
None. Our server software is custom written with the anticipation that we will have to interface with any number of legacy hardware and software systems. Compatibility is our responsibility - part of our service is that we exchange information with you in a format that's suitable for your needs.
CertSite assumes responsibility for making sure that the transactions we process are handled in a HIPAA-compliant manner. We can't address total HIPAA compliance for your organization, but we will keep abreast of changing regulations and make sure that at least your UM transactions are compliant with both HIPAA and local legislation. So you can enjoy the benefits of automation and at the same time have one less regulatory issue to worry about.
See our HIPAA compliance section for more information about HIPAA.
7. Want more information or have questions for us?
Please, contact us, we'll glad to help!
