Accelerate Smarter Utilization Management

Manual prior authorizations. Endless appeals. Regulatory timelines that can’t be missed. Helios® UM by Elligint Health brings automation, clarity, and real-time visibility to one of healthcare’s most complex operational challenges. 

Built for payers and provider organizations navigating rising regulatory scrutiny and growing expectations for better member experience, Helios UM streamlines prior authorizations, appeals, and grievances through configurable workflows, intelligent automation, and audit-ready documentation.

When used alongside Helios CM and Advanced Analytics as part of the unified Helios medical management platform, organizations gain a single system that accelerates authorizations, automates triage and timelines, improves data accuracy, delivers organizational intelligence, and ensures continuity of care across teams.

Helios® UM

Utilization management teams must balance three critical priorities: ensuring appropriate care, controlling unnecessary costs, and meeting strict regulatory timelines. Prior authorization requests, clinical reviews, appeals, and grievances must be processed quickly and accurately while maintaining complete audit trails, complying with evolving CMS and state regulations, and supporting timely access to care and a better experience for members.
Helios UM simplifies this complexity by automating key workflows, guiding reviewers with evidence-based criteria, and giving teams real-time visibility into authorizations, appeals, and grievances across the entire organization.

  • Automated Prior Authorization Management with configurable rules engines, smart routing, and auto-determination capabilities to accelerate turnaround times
  • Pre-Built UM Pathways and Configurable Workflow Templates that streamline authorization intake, clinical review, appeals, and grievance processes
  • Enterprise-Grade Rules Engine and Auto-Approval Workflows that automate prior authorization triage, approve eligible requests, and dynamically route complex reviews based on configurable clinical, policy, and operational criteria
  • Integrated Appeals and Grievance Management linking incidents, authorizations, and prior determinations to reduce administrative burden and improve traceability
  • Built-in Compliance Tracking aligned with CMS-0057-F, NCQA, and other regulatory requirements
  • Audit-Ready Documentation and Change Logs with full tracking of user actions, status changes, and decision rationales
  • Configurable Correspondence Templates that automate required communications with providers and members
  • Provider Portal Authorization Intake allowing providers to submit prior authorization requests, upload clinical documentation, and track status
  • Integrated Clinical Documentation Management supporting concurrent reviews and centralized record storage
  • Embedded Intelligence and Operational Dashboards providing real-time insight into authorizations, appeals, grievances, and workload performance
  • Evidence-Based Clinical Review Support through integration with leading guideline frameworks such as MCG and InterQual®, enabling reviewers to apply medical necessity criteria directly within UM workflows
  • AI-Enabled Prior Authorization Automation and Policy Transparency through integration with Itiliti Health, helping clients reduce prior authorization submissions by up to 30% and nearly eliminate prior authorization disputes

Embedded UM Performance Dashboards

Helios UM provides configurable dashboards and reporting views that give teams real-time visibility into utilization management activity, operational performance, and regulatory compliance. Dashboards help organizations monitor authorization volumes, turnaround times, appeals and grievance activity, and care team productivity — providing the operational insight needed to maintain compliance and improve decision-making. Key reporting capabilities include:

  • Authorization volume and turnaround time analysis
  • Appeals and grievance intake and resolution tracking
  • User productivity and workload visibility across UM teams
  • Compliance monitoring for regulatory reporting and accreditation requirements
  • Exportable reports and dashboards that support audits, CMS reporting, NCQA accreditation, and internal operational analysis
  • Configurable operational dashboards that provide real-time visibility into UM workflows and performance metrics

Connect Utilization Management to Care Management

Utilization management decisions have the greatest impact when they are connected directly to care coordination activities. When Helios UM is used alongside Helios CM, authorization decisions, clinical reviews, and coverage determinations become part of a unified care management workflow. Together, Helios enables organizations to:

  • Align utilization review with care management programs
  • Improve visibility across the member care journey
  • Reduce delays between authorization decisions and care delivery
  • Create a unified medical management platform for value-based care

These dashboards allow UM leaders to monitor operational bottlenecks, identify authorization delays, and ensure regulatory timelines are consistently met across the organization. For organizations requiring deeper analytical modeling and complex reporting across enterprise data sources, we offer Advanced Analytics by Elligint Health. 

Why Leading Payers and Provider Groups Choose Helios

Helios UM is part of the broader Helios medical management platform, giving organizations the flexibility, interoperability, and scalability needed to support evolving value-based care programs. Helios modules can operate independently or together to create a unified medical management environment. Through integration with partners such as Itiliti Health, Helios can help organizations reduce unnecessary prior authorization requests, automate policy checks, and streamline authorization workflows.

  • Automated, Configurable Care and Utilization Management Workflows supporting Medicare Advantage, Medicaid, and commercial programs with out-of-the-box templates
  • Integrated Care and Utilization Management Automation across authorizations, tasks, appeals and grievances, and compliance workflows
  • Extensive Library of Customizable Assessments with the ability to create new assessments using branching, scoring, mapping, and auto-population logic
  • End-to-End Referral Management and Outreach Tracking to strengthen care coordination and program engagement
  • Flexible Provider Engagement Options, including a built-in Provider Portal that supports utilization management, authorization review, medical necessity determination, clinical documentation submission, and appeals workflows
  • NCQA Pre-Validated Population Health Capabilities aligned with evidence-based standards
  • FHIR-Native Interoperability enabling seamless integration with EMRs/EHRs, partner systems, and enterprise data sources
  • Evidence-based Clinical Review Support and AI-enabled Prior Authorization Automation through integration with MCG and InterQual® and Itiliti Health using the Helios Partner Ecosystem that adds capabilities without complexity

Built for Enterprise Healthcare Environments

Helios is designed to integrate seamlessly with existing healthcare IT ecosystems. With FHIR-native interoperability, configurable workflows, and an extensible partner ecosystem that delivers targeted AI functionality, organizations can deploy Helios without disrupting existing clinical, administrative, or data infrastructure.

One Platform. Endless Impact.

  • Recognized as a top performer by KLAS Research
  • One system for care and utilization management
  • 90% configurable to align with your contracts and processes
  • Real-time operational insights that prioritize and drive action
  • Increased productivity & reduced administrative burden
  • Over 13M lives managed and industry-leading retention
  • FHIR-native from Day 1

Finally, Utilization Management that Doesn’t Require Workarounds