Rigorous review of literature.
Our clinical team meets daily to discuss new issues and developments in the medical field. Rigorous reviews of the following evidence-based sources are conducted: 

• publications and position statements of major medical organizations
  and peer-reviewed journals,
• standard medical textbooks,
• discussion with subspecialty panelists,
• and other sources of evidence-based clinical data.

Timely, thorough rules.
Our talented clinicians are provided with all the tools necessary to develop, test, and implement clinical rules that result from their literature review. This significantly shortens our cycle time for development of new rules and/or modification of existing rules. Rules are designed to reflect the evidence-based medical literature as closely as possible and to also incorporate exclusionary logic to maximize specificity and thereby decrease the incidence of “false positive” alerts.

Actionable clinical alerts.
Resulting from this process are actionable clinical alerts called Care Considerations. Care Considerations represent patient-specific discrepancies between the care that the patient is actually receiving as reflected in their claims history, and the care that they should be receiving as reflected in the evidence-based literature. Care Considerations are issued by phone, secure fax or mail to the treating physician and then to the member.