Utilization Management

JSON twin: https://www.healthaidb.com/software/utilization-management.json

Company Name

AGS Health

Product URL

https://www.agshealth.com/services/him-and-clinical-services/clinical-administrative-services/utilization-management-services/

Company URL

https://www.agshealth.com

Categories

• clinical Care
• administrative Operations
• patient Facing
• diagnostic Support
• revenue Cycle
• ai Clinical Documentation Integrity
• prior Authorization
• physician Enablement
• Clinical
• Administrative
• Diagnostic
• Revenue Cycle Management
• Clinical Documentation Integrity
• Clinical Denials And Appeals
• Clinical Prior Authorization Services
• Physician Advisory Services
• Clinical Administrative Services

Summary

AGS Health's Utilization Management services help healthcare organizations provide appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews.

Description

AGS Health's Utilization Management (UM) services assist healthcare organizations in delivering appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews. Their program ensures patient care aligns with current medical standards and optimizes resource allocation. Utilizing MCG and InterQual criteria, AGS Health confirms that cases meet established guidelines and determines the appropriate length of stay. They maintain clear communication with payers and internal teams, identify and mitigate potential risks such as overutilization, and analyze medical necessity denials to address root causes.

Api Available

unknown

Certifications

• SSAE 16 SOC 2 Type 2 Audit
• ISO/IEC 27001:2013

Company Founding

2011

Company Offices

• United States
• India
• Philippines

Compliance

• HIPAA
• HITECH
• SOC 2
• ISO 27001

Customers

Data Residency

US-only

Data Standards

• FHIR
• HL7 v2
• DICOM
• SNOMED
• ICD-10

Deployment Model

• SaaS

Features

• Prospective, concurrent, and retrospective reviews
• Evaluation of medical necessity and efficiency of services
• Utilization of MCG and InterQual criteria
• Determination of appropriate length of stay
• Clear communication with payers and internal teams
• Identification and mitigation of overutilization risks
• Analysis of medical necessity denials
• Collaboration with clinical documentation and denial teams to address root causes

Id

SW0833

Integration Partners

Integrations

• MCG
• InterQual

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

Os Platforms

• Web

Pricing Details

contact vendor

Pricing Model

subscription

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization

Product Code

SW0833

Product Name

Utilization Management

Ratings

Regions Available

• United States

Related Urls

• https://elion.health/products/ags-utilization-review

Release Year

Security Features

• Encryption
• RBAC
• Audit logs
• 2FA

Specialties

• Radiology
• Oncology
• Occupational Therapy
• Physical Therapy
• Surgery
• Infusion
• Diagnostics

Support Channels

System Requirements

Target Users

• clinicians
• nurses
• patients
• admins
• payers

Training Options

Type

product

User Reviews

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Utilization Management",
  "company_name": "AGS Health",
  "product_url": "https://www.agshealth.com/services/him-and-clinical-services/clinical-administrative-services/utilization-management-services/",
  "company_url": "https://www.agshealth.com",
  "related_urls": [
    "https://elion.health/products/ags-utilization-review"
  ],
  "product_code": "SW0833",
  "summary": "AGS Health's Utilization Management services help healthcare organizations provide appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews.",
  "description": "AGS Health's Utilization Management (UM) services assist healthcare organizations in delivering appropriate, efficient, and cost-effective medical care by evaluating the necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews. Their program ensures patient care aligns with current medical standards and optimizes resource allocation. Utilizing MCG and InterQual criteria, AGS Health confirms that cases meet established guidelines and determines the appropriate length of stay. They maintain clear communication with payers and internal teams, identify and mitigate potential risks such as overutilization, and analyze medical necessity denials to address root causes.",
  "categories": [
    "clinical Care",
    "administrative Operations",
    "patient Facing",
    "diagnostic Support",
    "revenue Cycle",
    "ai Clinical Documentation Integrity",
    "prior Authorization",
    "physician Enablement",
    "Clinical",
    "Administrative",
    "Patient-facing",
    "Diagnostic",
    "Revenue Cycle Management",
    "Clinical Documentation Integrity",
    "Clinical Denials And Appeals",
    "Clinical Prior Authorization Services",
    "Physician Advisory Services",
    "Clinical Administrative Services"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "clinicians",
    "nurses",
    "patients",
    "admins",
    "payers"
  ],
  "specialties": [
    "Radiology",
    "Oncology",
    "Occupational Therapy",
    "Physical Therapy",
    "Surgery",
    "Infusion",
    "Diagnostics"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "contact vendor",
  "license": "commercial",
  "company_offices": [
    "United States",
    "India",
    "Philippines"
  ],
  "company_founding": "2011",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Prospective, concurrent, and retrospective reviews",
    "Evaluation of medical necessity and efficiency of services",
    "Utilization of MCG and InterQual criteria",
    "Determination of appropriate length of stay",
    "Clear communication with payers and internal teams",
    "Identification and mitigation of overutilization risks",
    "Analysis of medical necessity denials",
    "Collaboration with clinical documentation and denial teams to address root causes"
  ],
  "optional_modules": [],
  "integrations": [
    "MCG",
    "InterQual"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "DICOM",
    "SNOMED",
    "ICD-10"
  ],
  "api_available": "unknown",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "HITECH",
    "SOC 2",
    "ISO 27001"
  ],
  "certifications": [
    "SSAE 16 SOC 2 Type 2 Audit",
    "ISO/IEC 27001:2013"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "Audit logs",
    "2FA"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization"
  ],
  "data_residency": "US-only",
  "customers": [],
  "user_reviews": [],
  "ratings": [],
  "support_channels": [],
  "training_options": [],
  "release_year": "",
  "integration_partners": [],
  "id": "SW0833",
  "slug": "utilization-management",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/utilization-management.json"
  }
}