Utilization Management


eHealthflex’s Utilization analysis solution provides Potential analysis, Coexisting analysis, Retrospective analysis, Drug utilization analysis of all the Medical Requirements.

Our Utilization Management services module promote timely and effective care of injured workers while providing employers with improved financial controls.

Nurse practitioners conduct first-level assessments on the basis of regional, evidence-based guidelines and can organize discussion with specialist clinician Advisors when these criteria are violated or not met. Registered nurses conduct both the efficiency Analysis and Telephone Case Management as required by law, offering a streamlined and effective mechanism to promote prompt and adequate care.

Components of our utilization review program include:

  • Potential analysis
  • Coexisting analysis
  • Retrospective analysis
  • Drug utilization analysis
  • Physician advisor/peer-to-peer review services

Platform for Coherent utilization review services

Cost Efficient

To be cost effective, through our software, we provide measures to ensure that our clients & customers are in the optimal available position. We strive to deliver the lowest and manageable pharmacy expenses.

Unrestrained Medical Examination

Organised with Panel of Certified Physicians whose area of practice is related to the treatment of claims. Detailed reports, health recommendations and employment status are issued to help streamline claims for full recovery or settlement direction and guidance.

Communicate with Doctor

Our module provides access to communication channels between the case manager and/ or the professional consultant in situations when queries occurs about the treatment regimen or current diagnosis.

Case Management Module


Our cellular and field-based case management systems offer cost-effective evidence-based solutions that avoid excessive and inadequate medication. Treatment is handled proactively on the basis of rules and evidence-based guidance intended to facilitate rehabilitation and reduce costs and to comply with jurisdictional regulations.

With this software, we aim to provide an effective way of managing the coordination of medical care & recovery and fulfil the return-to-work objectives.

Cellular Case Management

Our Cellular Case Management System is an early detection injury prevention programme. This service is staffed by registered nurse practitioners who offer essential information to employers, claimants and other health claims providers to coordinate treatment proactively. With this module, we intend to deliver time-efficient solutions & pace of contact also reduces the complications associated with the management of worker’s compensation claims.

Field Case Management

Our Module utilizes the result-oriented nurse services and concentrate on earlier detection and prompt claims-related interventions. The Field case managers and Physician Committee can pay attention to the range of problems in the fields of workers ' compensation, vehicle and disability. The results are geared towards complete recovery and return to work for the claimant.

Vocational Case Management

Addition to it, we also offer modules to capture vocational services for managing workers’ compensation, long term disability, general liability, auto liability, medical malpractice, ADA and employment discrimination claims.

Our Cost-Effective software solutions to provide Mandatory and Suitable treatment

Health management

The focused case management is done to ensure the adequate diagnosis and treatment in a prompt, cost-effective manner. Expected results are recovery & return to work for the claimant with the help of Assessment; and arrangement of medical services with the claimant's care physician, therapist, employer and insurance company.

Quick intervention

Determination of medical condition, planned length of care, capacity and case guidance recommendations through Instant monitoring of claims with early consultation with the claimant and patient’s physician.

Post Return to Work Analysis

For the purpose of communicating appropriate job conditions for all concerned, a comprehensive explanation of the pre-injury situation is provided. Exploration of the employer's ability to manage return to work either in full duty or in changed capacity. This service shall also include the detection of alternate work opportunities, the injured person should be informed of different job openings and qualified consultants shall prepare them for each appointment by including all relevant aspects of the position available.

Medical expenses prediction

It is structured to estimate an appropriate likely future health condition and to provide a scientifically reliable basis which is reserved for workers ' compensation, medical malpractice and liability claims could be set. Through correct forecasting of potential patient diagnosis, along with considering the multiple factors like drive exposure, and complex medical and legal information, this tool proves to be a powerful arbitration negotiation method.

Bill Analysis Module


Our software can help to process Worker’s ' compensation or multiline expenses. We utilize advance technology, which can be used along with highly trained medical experts and skilled nurses to review medical expenses. Bill analysis services can be streamlined for any regional or national network.

Maximum savings are achieved by steps including the implementation of fee schedules and billing.

  • Negotiation of charges if network incentives, reductions in the state fee schedule or other appropriate evaluation rationale are not available
  • Identification of irregular billing practices and repetitive charging

We help implement the following fee schedules, the standard and customary guidelines, proprietary code-specific clinical adjustments, and advanced mobile operator concessions. The front-end processing involves scanning, optical character recognition, printing, storage and distribution and retrieval of all information provided by the bill approval process.

By streamlining the medical decisions, the evidence-based guidelines; the bill analysis framework achieves full results by:

  • Implementing billing systems and fees ground rules, as set out by the department, to make the most of the best special discounts to our clients. Our module includes regular software updates to enforce consistency with state regulations & charges
  • Our Module will be able to find discrepancies in Duplicate bills and bundling & Unbundling
  • The integration, usage review services and systems of our Module ensure that compensation is made only for services accepted in the course of treatment and that allow for the optimization of pre-authorized data.

With our Module, we aim to deliver the Legal review services for the claimants, so that it becomes easy & hassle-free for the clients to get the lawful opinion about their case & take action for on any inappropriate act, if required.

Evaluate Medical Bills with Advance technology & Skilled Medical Experts

Medical Expense Analysis

Our platform help you coordinate closely with clients to find a suitable network partners for their claims. All network discounts are extended after the bill has been audited to the appropriate amount to ensure reasonable savings.

Hospital Expense Analysis

For hospital bills, we technically enable quantitative/qualitative bill analyses and review of relevant documents to ensure the charges are reasonable & correct. The audit services can also include negotiating high charges to ensure that large costs are charged at the fairest price possible.