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Prior Authorization2025-02-20T11:12:43+00:00

Eliminate Bottlenecks. Automate Workflows. Optimize Care Delivery.

From Administrative Burden to Revenue Optimization

Prior authorizations are one of the most significant administrative burdens on Providers, with complex requirements from Payers and manual processes that divert valuable resources away from patient care. Beyond the operational challenges, inefficient PA management can disrupt patient care, strain revenue cycles, and jeopardize compliance under CMS mandates like CMS-0057-F.

The Challenges in Prior Authorization

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A Major Source of Administrative Burden

PA processes demand extensive back-and-forth communication with payers, requiring providers to gather and submit clinical documentation manually. This consumes valuable time for both clinical and administrative staff, contributing to burnout and reducing focus on patient care.

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Revenue Management Risks

Denied or delayed authorizations can lead to postponed treatments, revenue losses, and increased reliance on costly appeals. These issues disrupt revenue cycles, impacting financial performance and care delivery.

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Fragmented and Manual Workflows

Without end-to-end automation, Providers face fragmented processes across EHRs, RCM systems, and payer portals. This leads to inefficiencies, redundant work, and longer PA turnaround times.

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Compliance Challenges with Evolving Regulations

CMS mandates, such as the CMS-0057-F, require Providers to adopt automated, interoperable systems for prior authorizations. Adhering to these standards while maintaining operational efficiency is a complex task for many organizations.

The Challenges in Prior Authorization

A Major Source of Administrative Burden

PA processes demand extensive back-and-forth communication with payers, requiring providers to gather and submit clinical documentation manually. This consumes valuable time for both clinical and administrative staff, contributing to burnout and reducing focus on patient care.

Revenue Management Risks

Denied or delayed authorizations can lead to postponed treatments, revenue losses, and increased reliance on costly appeals. These issues disrupt revenue cycles, impacting financial performance and care delivery.

Fragmented and Manual Workflows

Without end-to-end automation, Providers face fragmented processes across EHRs, RCM systems, and payer portals. This leads to inefficiencies, redundant work, and longer PA turnaround times.

Compliance Challenges with Evolving Regulations

CMS mandates, such as the CMS-0057-F, require Providers to adopt automated, interoperable systems for prior authorizations. Adhering to these standards while maintaining operational efficiency is a complex task for many organizations.

How We Solve it

Automating Time-Intensive Workflows

Our platform integrates directly with EHRs, RCM tools, and payer & provider systems to automate eligibility checks, data extraction and document submission. This eliminates repetitive manual tasks, accelerating the authorization process and freeing up resources.

Our Rules Engine leverages a dynamic Coverage and Decision Support System to evaluate payer policies, service types, and clinical requirements in real time. This reduces unnecessary back-and-forth with payers by ensuring that submissions meet all coverage criteria from the outset.

From patient and provider validation to service type checks and role-based access control (RBAC), our platform ensures that every PA submission aligns with payer and regulatory requirements. Utilizing advanced FHIR Implementation Guides (CRD, DTR, PAS), we guarantee consistency and compliance across all submissions.
Our DTR Smart App automatically generates and auto-populates payer-specific questionnaires, simplifying the documentation process and ensuring all necessary information is submitted in the correct format. This reduces delays and minimizes the risk of denials due to incomplete submissions.
Seamlessly exchange data with payers through our FHIR-enabled APIs, offering real-time eligibility checks, status updates and clinical data exchange. This fosters transparency, speeds up approvals, and enhances the patient experience by ensuring timely access to care.
By integrating with advanced validation and decision-support technologies, we simplify the implementation of CMS-0057-F requirements, ensuring Providers can confidently meet evolving interoperability and automation requirements.
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Why It Matters

Modernizing prior authorization unlocks tangible benefits for Providers:

Enhanced Patient Care

Expedite approvals to ensure timely treatments and improve patient outcomes.

Optimized Revenue Management

Reduce denial rates and secure faster reimbursements.

Regulatory Compliance

Seamlessly meet CMS interoperability and automation mandates.

Reduced Administrative Burden

Automate manual workflows and streamline PA processes.

Dive deeper into how we support Providers in addressing key challenges

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Let’s Redefine Prior Authorization Together

Streamline PA workflows, safeguard revenue, and enhance care delivery.

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Prior Authorization

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