Next-Generation Solution. Lifetime Value.

HELIOS can help you meet the new and evolving prior authorization and interoperability requirements, and improve your utilization and care management programs overall.

HELIOS is the only highly flexible, single-solution platform with integrated products to help you meet new prior authorization API and process requirements (both today and in the long term), leverage pre-built and configurable workflows for streamlined automation, and eliminate provider friction. Its integrated HELIOSum solution lets you streamline and automate authorizations, grievances, appeals, reviews, and more, while HELIOShub helps you eliminate provider abrasion by simplifying and expediting data interoperability with rapid FHIR® compatibility, no-code tooling, and a library of configurable APIs.

VirtualHealth knew the CMS requirements were coming to a head this year. But we also know organizations have more than CMS in mind. It’s why we spent the last few years making sure HELIOS, HELIOSum, and HELIOShub were ready to support. And because HELIOS offers 90% configurability out-of-the-box, it’s easy to feel confident about compliance now and in the future.

Below is information about key features and benefits of HELIOSum, and HELIOShub that may help you feel more confident about being compliant with the new rules.

With HELIOS, organizations can have everything they need in a single, intuitive solution. No extra tech-stack costs or IT support.

Just more efficient and effective care. It’s why HELIOS is used by commercial and community health plans, Medicare Advantage and Medicaid payers, and specialty care providers around the nation.

Thinking About Solving for Prior Auth APIs?

CMS made things tricky for payers by combining prior authorization and FHIR® in one ruling. But we’re glad they did. Interoperability is critical for frictionless, fast prior authorizations and collaborative, coordinated care.

Thankfully, with HELIOS you don’t have to worry about this. Our integrated FHIR® application, HELIOShub solves that with a library of configurable APIs and transformations for custom data structures to HL7® FHIR® formats. This means you can easily:

  1. Implement a HL7® FHIR® Prior Authorization API
  2. Improve or implement a Patient Access API
  3. Be compliant with evolving API requirements
  4. Eliminate provider abrasion and frustration with a Provider Access API (and our dedicated Provider Portal)
  5. Use a Payer-to-Payer FHIR® API

With HELIOShub, in 20 minutes you can: start a UM data feed; transform it to FHIR®; validate it in real time; meet new CMS interoperability requirements; and have it ready for immediate use.

A Better Workflow Automation Solution

Powered by real-time data, automated workflows, intelligent automations, expansive integrations, and a network of industry-leading clinical and technology partners HELIOSum unifies providers, care managers, and UM teams on a single platform to revolutionize UM and CM activities simultaneously.

Our HELIOS platform offers automated prior authorizations, AI-powered decisioning, pre-built UM pathways, a configurable rules engine, and out-of-the-box /custom clinically-integrated workflows to streamline reviews, appeals, grievances, reviews, reporting, and more.

  • HELIOS has the industry’s most configurable workflow rules engines, offering out-of-the-box workflows (ask us how to see these) and the ability for clients to easily configure their own.

  • HELIOS’s automations and rules engine drive simple and complex workflows with great efficiency, minimizing administrative tasks and potential audit errors. 

  • Use out-of-the-box, clinically-integrated workflows or create your own quickly and easily. HELIOS provides a system of configurable triggers, criteria, and rules that support full spectrum event-driven workflows, and it includes a variety of rules engines to automate workflows for great efficiency and productivity gains.

  • Automated prior authorizations, streamlined electronic prior authorizations, and AI decisioning.

  • HELIOS is integrated with both MCG’s and Change Healthcare’s InterQual clinical guidelines to help enhance accuracy and compliance. HELIOS is integrated with evidence-based Clinical Practice Guidelines (CPGs) and can also use internal guidelines to support organization-specific medical policy or state guidelines.

Aligning CM and UM in One Place

HELIOS  is designed to unify CM and UM and is a good fit for organizations looking for a new CM solution or to replace an outdated one that’s just not cutting it.

The HELIOS platform is a highly configurable, scalable, flexible, web-based solution that works on all standard supported browsers, enabling easy access for contacts across the care continuum and optimized coordinated care. The first platform built for value-based care, HELIOS is 90% configurable out-of-the-box, offering precision control over the industry’s most sophisticated templates, advanced rules engine, and automated workflows. HELIOS unifies providers, care managers, and UM teams on a single platform to revolutionize UM and CM activities simultaneously. 

  • Integrated solutions for CM, UM, DM, LTSS, Home Health, Behavioral Health, Telehealth, Data Interoperability

  • Unmatched flexibility to enable teams to support complex cohorts, multiple lines of business, and diverse population needs

  • A single solution for CM and UM teams to drive seamless alignment, communication, and collaboration

  • Unparalleled intuitive user experience that makes it easy to use, and supports significant gains in efficiency and productivity. The platform itself offers a simple navigation menu, and only takes 1-3 clicks to get to anywhere in the platform. 

HELIOS also operates as a closed-loop ecosystem for optimized care coordination, working with a network of leading industry and technology partners to offer integrations for identifying and addressing social determinants of health, predictive analytics for population health needs, automating prior authorizations, and comprehensive quality reporting capabilities for auditing and compliance.