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Meet Predictal
Healthcare leaders face a growing storm of challenges: siloed data, manual processes, rising costs, tightening regulations, and increasingly empowered consumers. These pressures slow down decisions, add administrative burdens, and compromise patient outcomes. Predictal cuts through the noise.
By combining intelligent automation and AI, Predictal replaces outdated systems with a smarter, faster, and more connected approach to care management – delivering better decisions, faster approvals, and personalized member experiences at scale. Developed in partnership with leading clinicians, Predictal is setting a new standard for patient-centric care.
Approvals in seconds, not days
Clinicians and UM teams using Predictal are reducing cost-per-authorization by 75% and turnaround time by ~ 80%.
The Predictal Advantage
Meaningful outcomes for clinicians, patients, and health plans
Healthcare doesn’t have to be an unbalanced, zero-sum game. Predictal delivers transformative results for all across every UM touchpoint.
Predictal helps our clients achieve:
- 75% decrease in average cost per authorization
- ~80% reduction in auth turnaround time
- 40% of prior auths instantly approved
- ~50% increase in RN and MD cases per day
- 25% reduction in emergency room visits
Whole-person care management
Predictal™ is a configurable solution including Utilization, Case, Disease, and Grievances Management and Auto Authorization Hub (AAH, UM, CM/DM, AGM). Choose individual modules or integrate the full solution.
Choose individual modules or integrate the full solution
Predictal is a unified platform offering your care team a single source of truth. Teams with specific goals have the option to pick and choose modules as needed.
Authorization Automation Hub
Use AI to examine, identify, and approve claims to increase authorization rates. Automated workflows, current regulation guidelines, and self-service configuration alleviate administrative burden. Users consistently achieve 'Auth by Exception' targets and obtain determinations within seconds.
Predictal improves the provider experience with capabilities such as Gold Carding, vendor interoperability, routing to delegates, and increased platform adoption.
Utilization Management
Predictal delivers evidence-based evaluations using near real-time member/patient data, multi-channel communication, and updated medical policies and guidelines. Prevent overtreatment costs and increase speed-to-market in a dynamic legislative environment, all while providing real-time communications to members and providers.
With the most urgent and costly cases prioritized, and clinical criteria integrated within our system, your staff can work at the top of their licenses.
Case and Disease Management
Engage more members with no staffing increase. Designed and used by experienced clinicians, Predictal fosters meaningful, low-friction engagement between payers, members, and care management teams.
Create configurable 360-degree member/patient profiles through AI-driven analysis and advanced identification and stratification analytics. Case and disease managers can work together to deliver personalized experiences. NCQA Pre-Validated to support Health Plan Accreditation.
Appeals and Grievances Management
Adapt to changing regulations with intuitive self-service capabilities and streamlined documentation processes. Reduce resolution and response times through AI-powered workflows and real-time reporting. Built-in features like automated EDI 278 transaction messages ensure audit readiness and simplify compliance by minimizing the risk of penalties.
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Video | Predictal in Action
Discover the “why” behind Predictal. In this short video, we break down the challenges our clients faced before Predictal and the measurable outcomes they’ve achieved since implementing it. You’ll hear why we built the solution, what sets it apart, and how it’s helping organizations move from reactive to predictive decision-making in real time.
