Prior Authorization
Real-time Prior Authorization Guidance and Decision at the Point of Care
The Prior Authorization (PA) Module is an end-to-end PA solution for providers and payers. Our tool streamlines PA submissions and decision processes, saving valuable time for users.
Our Prior Authorization module enables providers to validate a PA request against payer guidelines, automatically submit it, and then to receive instant decisions from the payer. Similarly, it enables payers to automate PA decisions and serves as a decision support engine to help streamline complex utilization management processes.
The solution can integrates seamlessly with a provider’s EMR and a payer’s utilization management system by leveraging the Fast Healthcare Interoperability Resources standards (FHIR), or it can be accessed via a web-based application. Call us today to talk about integrations!
Features
Automated PA
- Efficient process and adjudication near real-time access to EMR and demographic data PA Requirements Identification
PA Requirements Identification and Determination
- Efficient PA process and adjudication
- Identify PA requirements based on payers, plans, and groups
- Identify at the point of care whether members meet PA requirements
Providers PA Submission
- Submit PA requests directly to payers through our automated PA tool
- Easy-to-use, web-based forms for digitizing and automating PA submissions
Payers Clinical Decision Support Tool and Automated Approvals
- For guidelines selected by payers, enables automated approvals and responses to providers
- Near real-time access to EMR and demographics
Benefits
- Faster care for members and reduced administrative burden
- Enables healthcare plans to engage the members for optimal health outcomes
- Improves access to care for members, enabling better health outcomes and cost savings through reduction in avoidable hospitalizations and emergency room utilizations
- Enables payers to make efficient, effective decisions on PA requests by passing the PA submissions through an advanced natural learning processing-based AI engine