Criteria Maintenance Application Group

The Criteria Maintenance group of applications lets healthcare payers set up the evaluation criteria that they need during utilization review, clinical editing, and capitation processing to help them make authorization decisions based on established medical criteria. The applications in this group are:

1. AE Criteria by Diagnosis

2. AE Criteria by Procedure

3. Alternate Criteria Definition

4. Clinical Editing Criteria

5. Clinical Organ/Disease Panels

6. CPT-4 to ICD-10 Conversion

7. CT/SC/DI Criteria

8. Diagnosis Criteria M&R

9. Diagnosis Edit Criteria

10. Length of Stay by Diagnosis

11. Length of Stay by Procedure

12. Length of Stay Conversion

13. Medical Admission Criteria

14. Optimal Recovery Guidelines

15. Procedure Criteria M&R

16. Procedure Edit Criteria

17. Same Day/Follow-Up Procedures

18. SSO Waiver Criteria

19. Surgical Admission Criteria

20. Surgical Indications M&R