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Secure Exchange Solutions

What is SES SPOT?
SES-SPOT is an AI-powered solution that supports value-based care by delivering real-time critical insights that speed the prior authorization process while ensuring the appropriate payer coverage criteria are met.

What it does?
SES SPOT relies on advanced AI to ingest clinical policy and query medical records. By automating the discovery and analysis of critical insights in the medical record, SES SPOT identifies the appropriate services and supports the approval of treatments.

SES SPOT integrates into the physician order workflow, expediting prior authorizations.

  • SES SPOT evaluates payer criteria and returns real-time alerts if corrections are needed, identifies coverage gaps, and determines if the record contains enough information for authorization.
  • SES SPOT evaluates the patient chart to determine if the physician order and payer criteria align, reporting missing information back to the physician to modify the order and avoid controllable loss.

Why it matters?
The prior authorization process is costly and labor intensive for healthcare providers. For every ambulatory physician, a supporting FTE spends 10-25% of their time dealing with pending and denied prior authorizations alone. And, limited perspective on payer criteria puts providers at risk for unpaid procedures due to lack of coverage.

SES SPOT delivers real-time decision support to reduce controllable losses and streamline the flow of clinical data to payers by:

  • Improving the efficiency of prior authorization and coverage evaluation
  • Reducing the administrative burden of reviewing clinical information and payer coverage criteria
  • Improving accuracy of clinical review and decision-making
  • Freeing time for providers to deliver enhanced patient care

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