Prior Auth Suite - Healthchain

Seamless Prior Authorization Powered by Intelligent FHIR API Integrations

Health Chain’s Prior Auth Suite digitizes prior authorization workflows for Payers, Providers and Patients in order to reduce administrative burden, accelerate care decisions, and create a more seamless care journey for members.

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The Launchpad for Prior Authorization Innovation

Health Chain’s Prior Auth Suite transforms the prior authorization process with seamless API integration, omnichannel prior auth handling and real-time decisioning.

CRD, DTR & PAS APIs

Provides the end-to-end FHIR-based APIs required to stand up the Prior Authorization API, optimizing workflows while achieving compliance with CMS-0057-F.

Omni-Channel Intake

Handle Prior Auth submissions received from direct EHR connections (FHIR), existing Provider Portal (x12) & Fax-Based Authorizations (PDF).

CQL Engine

Integration with existing policy vendors + handling of CQL logic to seamlessly support the FHIR-based Prior Auth API.

Admin Dashboard

Monitor Prior Authorization status across auths routed to delegated vendors & Payer UM tools while monitoring key PA-related metrics in order to have a holistic view of the Prior Auth API ecosystem.

Why choose Prior Auth Suite?

End-to-End Workflow Automation:

Streamlines the entire prior authorization lifecycle by enabling the CRD, DTR, and PAS APIs to be integrated directly with existing Prior Authorization and Utilization Management ecosystems.

Omni-Channel Submission and Connectivity:

Supports seamless prior auth submission through multiple channels – including direct EHR integration, provider portals and fax-based authorizations – supporting individual provider workflows and maximizing adoption.

Real-Time Insights:

Brings real-time clinical, claims, admin and provider data into the UM decisioning process to enable evidence-based clinical decisions while minimizing delays caused by information chases.

Integration with Prior Auth + UM Environment:

Integrates with industry-standard criteria (InterQual/MCG), payer-specific policies, and utilization management tools, offering secure FHIR-X12 transformations and adaptive routing to optimize integration.

Comprehensive, CMS-Compliant Analytics:

Delivers built-in analytics, detailed reporting, and audit-ready documentation that enables compliance with CMS-0057-F mandates

Future-Proof Care Coordination

Ecosystem-Wide Interoperability

Ensures future-ready interoperability by enabling real-time FHIR-X12 integration, automated vendor routing, and seamless adaptability to evolving healthcare standards.

Utilization Optimization

Optimizes utilization by delivering clinical data by default – streamlining medical necessity reviews and reducing payer-provider friction to accelerate more accurate decision-making.

Improved Patient and Provider Experience

Improves the Patient and Provider experience by leveraging real-time longitudinal member records to minimize administrative burden and enable data-driven decisions – ultimately accelerating clinical decision-making and reducing care delays.

Ready to Transform Prior Authorization and Utilization Management?

Experience the future of Prior Authorization with seamless, scalable, and intelligent FHIR API integrations. From CRD, DTR, and PAS enablement to omni-channel submissions, our Prior Auth Suite empowers payers and providers to accelerate approvals, reduce administrative burden, and optimize utilization management. Unlock real-time decisioning, integrate effortlessly with UM tools and policies, and deliver a faster, more connected care experience for patients and providers alike

Take the next step toward Prior Authorization and Utilization Management.

Access our Docs to read more about Prior Auth Suite.

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