Electronic Prior Authorization Solution: Smart Authorization Gateway
The prior-authorization process is a resource-intensive function that is essential for managing costs but which taxes workforce resources and drives member and provider abrasion.
Overview
The prior-authorization process is a resource-intensive function that is essential for managing costs but which taxes workforce resources and drives member and provider abrasion. Automating this process can yield a wide range of benefits, but the challenge has always been to build a system that differentiates between valid, routine authorization and those deserving additional scrutiny.
How Does the HealthUnity Smart Authorization Gateway help with Electronic Prior Authorization?
The HealthUnity Smart Authorization Gateway applies the power of AI combined with deep experience in workflow automation and care/cost management to enable payer organizations to strike the right balance between efficiency and cost control. Utilizing an end-to-end FHIR®-enabled workflow, Smart Auth Gateway pulls relevant claims and EMR data, then applies advanced adjudication logic to either automatically generate the authorization or route the claim and associated content to the appropriate team member for human assessment.
The result is a fast and efficient system with high-pass rates and appropriate payments, saving time, cost, member satisfaction, and provider abrasion while reducing unnecessary delays in care.
How is Smart Authorization Gateway different?
Smart Authorization Gateway is built to be conformant with FHIR implementation guides recommended to improve prior authorization processes and reduce burden on providers and negative impact for patients. Smart Authorization Gateway is also built for compliance with HHS regulations, including requirements from the CMS Interoperability and Prior Authorization Final Rule (CMS-0057), ONC interoperabilty data and exchange requirements, including translation to and from X12 278 specifications. Further differentiating Smart Authorization Gateway is EMR integrations and automation to streamline the clinical documentation requirements to complete authorizations in turnaround times that reduce delays and inefficiencies for providers, payers, and patients.
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