Accelerate Smarter Utilization Management
Helios® UM by Elligint Health is utilization management software built for health plans and provider organizations managing prior authorizations, appeals, and grievances under rising regulatory scrutiny — turning manual, fragmented reviews into automated, audit-ready determinations across every line of business.
What is Helios UM?
Helios UM is utilization management software that brings together the automation, compliance tracking, and real-time visibility organizations need to manage prior authorizations, appeals, and grievances with confidence.
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, utilization management software, 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.
Proven Results for Payers and Providers
INTERLINK Health used Helios UM, our utilization management software, and Helios CM to earn URAC Accreditation in Utilization Management for its Cancer CARE for Life program — the kind of third-party validation health plans look for before trusting a partner with delegated review. See exactly how INTERLINK put Helios to work, or browse our full library of resources and case studies.
Who Helios UM Serves
Utilization management looks different for every organization. Helios UM, our utilization management software, configures to the regulatory requirements, contracts, and review criteria you manage. Not the other way around.
Health Plans & Payers
Talk with us about streamlining prior authorization, automating utilization review, and coordinating care across teams without adding headcount.
Value-Based Care Organizations
Ask how Helios aligns performance, quality, and cost across value-based contracts and provider networks.
MLTSS Programs
Find out how Helios coordinates HCBS services, long-term supports, and state-specific waiver requirements in a single system of record.
Government and Community Programs
Learn how Helios supports Medicaid managed care, public health initiatives, and community-based care coordination.
Extend the Power of Helios UM
Helios CM extends Helios UM, our utilization management software, with integrated care management. Helios Text and Helios Visit add secure, built-in tools for member messaging and telehealth, so no separate software is required. And because Helios UM and Helios CM run on the same platform, utilization management software and care management work as one connected system, not two.
Helios CM
Utilization management decisions have the greatest impact when they’re connected directly to care coordination activities. Helios UM integrates seamlessly with Helios CM, so 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
Helios Visit®
Helios Visit is a built-in telehealth tool that enables secure, HIPAA-compliant video conferencing, audio calls, instant messaging, and two-way file exchange with members from a computer, smartphone, or tablet without any additional software.
- Secure, HIPAA-Compliant Video Visits
- Real-Time Chat and File Exchange
- No App Installation Required
- Device – and OS – Agnostic Access via smartphone, tablet, or desktop
- Integrated Across Helios Care Management Software and Workflows
Helios Text®
Helios Text enables secure outbound text messaging to individual members directly from Helios, with pre-configured and customizable message templates.
- Secure SMS Messaging directly from within workflows
- Pre-Built and Customizable Templates for speed and consistency
- Two-Way History and Delivery Tracking
- HIPAA-Compliant Communication across member populations
- Increased Member Engagement promotes adherence to care plans and improved member experience
Why Leading Payers and Provider Groups Choose Helios
Helios UM is utilization management software built to give organizations the flexibility, interoperability, and scalability needed to support evolving value-based care programs, as part of the broader Helios medical management platform. 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.
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Automated, Configurable Care and Utilization Management Workflows
Supporting Medicare Advantage, Medicaid, and commercial programs with out-of-the-box templates.
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Integrated Care and Utilization Management Automation
Across authorizations, tasks, appeals and grievances, and compliance workflows.
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End-to-End Referral Management and Outreach Tracking
To strengthen care coordination and program engagement.
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Extensive Library of Customizable Assessments
With the ability to create new assessments using branching, scoring, mapping, and auto-population logic.
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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
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NCQA Pre-Validated Population Health Capabilities
Aligned with evidence-based standards
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FHIR-Native Interoperability
Enabling seamless integration with EMRs/EHRs, partner systems, and enterprise data sources.
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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.
The Utilization Management Software You Can Trust
Helios UM, our utilization management software, is HITRUST CSF certified, NCQA Pre-Validated for Population Health, and built to support URAC-accredited utilization management programs, giving your organization independent, third-party proof of security, compliance, and clinical rigor.
Frequently Asked Questions
Helios UM (utilization management software) automates prior authorization, appeals, and grievance workflows — clinical reviews, determinations, and regulatory compliance tracking. Helios CM manages the broader arc of member care: care plans, risk stratification, and outreach. They’re built to work together, but organizations can start with either module and add the other when ready.
Yes. Helios UM (utilization management software) is FHIR-native, enabling seamless integration with EMRs/EHRs, partner systems, and enterprise data sources without disrupting your existing IT ecosystem.
Helios UM includes built-in compliance tracking aligned with CMS-0057-F, NCQA, and other state and federal requirements, with audit-ready documentation and full change logs for every determination.
Helios UM integrates with MCG and InterQual® for evidence-based medical necessity criteria, and with Itiliti Health for AI-enabled prior authorization automation — helping organizations reduce prior authorization submissions by up to 30%.
Helios UM’s rules engine, workflow templates, and correspondence templates are configurable to your existing clinical, policy, and operational criteria — so the system adapts to how your organization already reviews and determines cases, not the other way around.
How is Helios UM different from Helios CM?
Helios UM (utilization management software) automates prior authorization, appeals, and grievance workflows — clinical reviews, determinations, and regulatory compliance tracking. Helios CM manages the broader arc of member care: care plans, risk stratification, and outreach. They’re built to work together, but organizations can start with either module and add the other when ready.
Does Helios UM integrate with our existing EHR and claims systems?
Yes. Helios UM (utilization management software) is FHIR-native, enabling seamless integration with EMRs/EHRs, partner systems, and enterprise data sources without disrupting your existing IT ecosystem.
What regulatory requirements does Helios UM support?
Helios UM includes built-in compliance tracking aligned with CMS-0057-F, NCQA, and other state and federal requirements, with audit-ready documentation and full change logs for every determination.
Which clinical review guidelines does Helios UM support?
Helios UM integrates with MCG and InterQual® for evidence-based medical necessity criteria, and with Itiliti Health for AI-enabled prior authorization automation — helping organizations reduce prior authorization submissions by up to 30%.
How configurable is Helios UM to our existing workflows?
Helios UM’s rules engine, workflow templates, and correspondence templates are configurable to your existing clinical, policy, and operational criteria — so the system adapts to how your organization already reviews and determines cases, not the other way around.
One Platform. Endless Impact.
- Care and utilization management software in one connected system
- 90% configurable to fit your contracts and workflows
- Real-time insights that surface priorities and drive action
- Less administrative burden, more time for care teams
- Cloud-based, FHIR-native, and built on AWS from Day 1