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Craneware Enhances Industry-leading Medical Necessity Verification Solution

ATLANTA, May 8, 2012 – Craneware, Inc., the market leader in automated revenue integrity solutions, today announced the availability of new features to InSight Medical Necessity®, its all-payor medical necessity verification solution. Because medical necessity is one of the greatest causes of denials today, representing a threat to provider organizations’ revenue integrity, Craneware has enhanced InSight Medical Necessity to help healthcare organizations save staff time in ensuring compliance with medical necessity and prior authorization requirements.

Medical necessity verification is an essential front-end component and best practice for optimal revenue cycle performance. According to a recent American Hospital Association survey of more than 2,000 hospitals, nearly 80% currently list medical necessity as the organization’s top reason for complex denials. It is a daunting task for clinical and administrative staff to manually attempt to track payors’ medical necessity policy updates and prior authorization requirements. InSight Medical Necessity enables staff to quickly check medical necessity for all payors from any Internet-accessible location.

Building on the most comprehensive set of payors’ medical necessity requirements available today, enhancements to the web-based InSight Medical Necessity include:

  • Customizable keyword picklists that support users with limited coding knowledge to choose the appropriate procedures when performing medical necessity validations
  • Commercial payor prior authorization coverage for ensuring accurate patient access checks in accord with each payor’s unique prior authorization policies
  • Newly expanded reporting capabilities that identify medical necessity results by Current Procedural Terminology (CPT) code and physician, which helps administrators identify and prioritize common problem areas and opportunities to provide education

“As hospitals and healthcare organizations work to ensure revenue integrity in order to continue providing quality healthcare to their communities while remaining as costeffective as possible, it is vital that they implement automated tools that improve overall business processes,” said Keith Neilson, CEO of Craneware. “Spurred by our commitment to providing software that supports accurate, efficient and sustainable business processes in healthcare, and armed with years of lessons learned, Craneware has enhanced our medical necessity solution to address the most significant challenges associated with medical necessity verification, coding and administrative reporting. Timely accurate medical necessity communications help honor the needs of patients and providers to know what to expect from payor plans.”

InSight Medical Necessity supports fast verification of medical necessity in any area of the healthcare organization’s operations, from scheduling and registration to order entry and medical records. Enhanced reporting allows administrators to identify problem areas by tracking and trending medical necessity and prior authorization failures by procedure and physician. Medical necessity is verified against a comprehensive payor requirements database with weekly auto-updated coverage for major state, federal, nonprofit and commercial payors in the U.S. Having an effective, efficient process for medical necessity verification in place will ease the transition when ICD-10 takes effect.

InSight Medical Necessity automatically issues Advance Beneficiary Notices (ABNs) and patient responsibility waivers using up-to-date CPT, HCPCS and ICD-9 codes, and it links directly to the chargemaster file to reflect actual pricing on the ABN.

To learn more about Craneware and to receive a demonstration of the enhanced InSight Medical Necessity solution, visit the company at the National Association of Healthcare Access Management (NAHAM) 38th Annual Educational Conference and Exposition, May 8-11 in San Diego, booth #509. Craneware is a business partner member of NAHAM.

About Craneware
Craneware (AIM: CRW.L) is the leader in automated revenue integrity solutions that improve financial performance for healthcare organizations. Craneware’s market-driven, SaaS solutions help hospitals and other healthcare providers more effectively price, charge, code and retain earned revenue for patient care services and supplies. This optimizes reimbursement, increases operational efficiency and minimizes compliance risk. By partnering with Craneware, clients achieve the visibility required to identify, address and prevent revenue leakage. To learn more, visit

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