There are several factors that drives overall healthcare costs. One significant factor is over utilization - i.e authorization of procedures or treatments that are medically unnecessary. Fraud and Abuse is also prevalent in certain section especially overuse of prescription drugs etc. Healthcare payers have to constantly make appropriate decisions with respect to authorization of care. They not only have to pay attention to medical necessity but also regulatory guidelines with respect to response times for certain types of authorization requests.

A solid medical management software should not only provide medical decision support systems to help healthcare payers make appropriate medical decisions but also be able to facilitate interoperability among the disparate systems to assemble all relevant patient data including claims, labs, diagnostics, drug data into a single patient health record (PHR) or an electronic health record. ZeOmega's Jiva is a patient-centric medical management software that allows healthcare payers to consistently make appropriate decisions during utilization review i.e concurrent reviews, retrospective reviews, medical necessity reviews so as to ensure utilization of healthcare is based on medical need. ZeOmega's Jiva integrates with medical decision support systems such as InterQual and Milliman Care Guidelines to drive consistent decision making based on medical necessity.

A solid utilization management software should also be able to drive efficiencies through auto approval rules and rules to identify fraud and abuse. Insights obtained from these rules are used to automatically drive workflows in the system. For e.g an inpatient request for a 2 day hospital stay for a C-section delivery can be auto approved without manual nurse intervention, resulting in nurses spending time on reviewing medical necessity for those cases that need additional medical review. Finally, ZeOmega's utilization management software is also being deployed in the physician based medical management scenarios, where physicians are able to make authorization requests and receive auto approvals online via the physician portal.