Current Situation
Providers, payers, and members desire a streamlining now mandated by CMS.
Goals and Objectives
Enable fast, documented, decisions around high-cost, highly fraudulent-capable medical procedures.
Technology Deployed
A rules data store to determine prior authorization requirements by procedure
Workflow to route the prior authorization transaction
APIs to integrate to provider and payer care management and medical management software
Use Case Summary
Reduce complexity/cost and achieve fully automated prior authorizations to meet mandates and provide member and provider satisfaction.