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Everything you need to make fast accurate admission decisions

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Understand the risk before the "write-offs"

AutoGov's eligibility decision support tool helps in nursing homes and hospitals.

What is CaseVue?

With CaseVue, you will be able decide whether or not to admit a Medicaid patient with just a touch of a button. Your write-offs will decrease and your census will increase. CaseVue is part of a comprehensive platform used by government agencies and healthcare providers to supply decision support and has successfully risk scored more than 30 million patient cases. CaseVue gives facility admission teams a more complete picture with which to make an admission decision and CaseVue software will easily integrate with existing organizational processes and requires no downloads.

Features and Benefits

CaseVue contains the following solution features:

Predictive Analytics

The CaseVue product suite utilizes advanced data mining and sophisticated predicted analytics to generate a comprehensive list of predictive factors, then deploys these factors in the form of scoring engines to ensure usefulness.

Case Management

CaseVue is designed to facilitate the management and distribution of cases submitted through our active portal. Administrators use the built-in workflow to manage information submitted through the active portal. Approve, deny, reject, pend, escalate, and remand to quality control reviewers. CaseVue review windows are designed to provide case managers with a comprehensive view of all data necessary and relevant to accurate and timely decision making.

Business Intelligence Reporting

Comprehensive reporting capabilities are offered through this advanced reporting facility. Standard and ad hoc reporting are available to users and administrators. The entire product suite supports the creation of "audit logs" that, when combined with the suite's reporting abilities, provide administrators support for case reviews, appeals and hearings.

Risk Mitigation

CaseVue reduces the threat of a bad admission decision. Risk is identified by the CaseVue predictive analytics and presented in a simple and user-friendly score. For years, banks have been using credit scores to help predict the likelihood of repayment by the borrower. Credit scoring engines pull payment and debt information and, using risk assessment algorithms, assign a score. CaseVue works similarly; it will accurately score the risk of a Medicaid denial by the state.

Full Account Control

In the latest version of CaseVue, we have made an all-out effort in order to accommodate your company on many levels. We have given you the ability to "grow" your company both inside CaseVue and in the real world.

What CaseVue will do...
  • Empower employees to quickly make informed admission decisions
  • Establish consistency within the admission process
  • Reduce the risk factor for each Medicaid admission
  • Confidently increase Medicaid pending, thus increasing census
  • Create best practices organization-wide utilizing CaseVue's reporting functions
  • Increase organizational quality improvement initiatives
  • Improve performance evaluations of admission staff
  • Reduce the number of days to Medicaid approval
  • Support denial appeals for patients already in the system
  • Stablize paying census at entry and as Medicare residents transition to Medicaid
  • Gain access to timely data identification and verification services
  • Reduce fraud and abuse; remove “pay and chase”

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AutoGov's eligibility decision support tool helps in nursing homes and hospitals.

CaseVue Highlights
CaseVue DataOur formulas use hundreds of bits of data gathered from the most credible sources available today.
CaseVue ScoresCaseVue risk scores are the result of calculations from the most complex predictive models used in healthcare eligibility.
CaseVue VerificationCaseVue provides real time verification on the most important parts of medicaid eligibility decisions.


Since its beginning, CaseVue has been carefully designed to render the complex simple. The complex formulas that drive the scoring engines in CaseVue are designed for ease of use and interpretation by all kinds of users. Caseworkers, case managers, business office managers, and executives alike have access to a real time score delivered to their desktop computers. The score is the result of a multi-layered algorithm or formula configured to suit the business process needs of our customers. The predictive analytics driving the scoring process in our base engines is derived from millions of previous cases and scores that predict the likelihood and level of risk in a particular situation. In the case of eligibility for government programs, the score from 1 to 100 ranks the likelihood that a case is eligible to receive assistance and assist users with their determination decisions.

What does the algorithm look like?

A typical CaseVue scoring engine consists of more than 400 lines of code. The more complex the program, the more lines of code that make up the scoring engine. Each case scored passes (with its data) through the scoring engine algorithm. A typical case is scored in less than a second. The CaseVue scoring engines and their exact contents are the intellectual property of AutoGov and are considered trade secrets.

How does a risk score affect timeliness and efficiency?

Identifying risk at any point in time during the life of a case is critical. Eligibility determination, for example, is a dynamic process. Cases are in motion. They change and become more or less risky based on the substance of the case, the amount of information in the case and the amount of time that the case has been in process before a final decision. Generally, as cases age their risk level increases, particularly if critical pieces of information remain “missing. CaseVue’s scoring engines are designed to encourage usage that ensures that the level of risk is measured as a case is in motion.


Each CaseVue scoring engine is different. Government assistance programs (Medicaid, LTC, Food Stamps, SCHIP, TANF) each have unique data sets that reflect the separate rules and distinct business processes used in determining eligibility. AutoGov owns and maintains a “base engine” for each of these programs. Common factors do exist among the various scoring engines, but there are factors that are unique to a specific program. Generally, the type of information common across programs relates to identity, residency, citizenship, income and assets.

Where does the data come from?

CaseVue fuses data from a variety of data sources to provide real time scores to users. Basic case data often originates from the case management system of record. AutoGov often supplements this information by fusing reputable third party data available from its strategic business partners. In addition, AutoGov holds agreements with specialty data providers for use in unique circumstances.


CaseVue provides real time verification on the most important parts of Medicaid eligibility decisions.

What is the distinction between rule adherence and risk identification?

Almost all eligibility systems have “rules engines” that help facilitate a case as it moves through the process of determining eligibility. This fact is especially true with state-based eligibility systems. Program rules are very specific and have certain thresholds – rules - designed to support a business process that results in a YES or NO decision. While CaseVue’s scoring engines consider the rules as a critical component of the engines, they are not necessarily part of a risk score in and of themselves. The predictive factors weigh risk to the group or person required to make a decision. For example, a state may have a rule that limits total assets to $2,000 in long term care eligibility. This same case may be risky with only $1,700.

CaseVue Pricing

casevue cost CaseVue works with you and for you. We have several different pricing options that are available to you and your company. If you have any questions, call us and we can help find a plan that makes sense for you and your company.

Pay Per Score

AutoGov offers CaseVue on a “per score” basis as a standard pricing model. There are no minimums and you can cancel your account at any time. Your account will be billed when a new score is given.

Payment Options Availiable

Currently, CaseVue accepts payment by Credit Card (Visa, Mastercard, and American Express) and we can also accept ACH/Checking Account payments. Payment information can be changed at any time by someone with a Company Admin user role in CaseVue.

AutoGov's eligibility decision support tool helps in nursing homes and hospitals.

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