What You Should Know:
– The full automation of prior authorization at the point of care leads to improved member experiences, enhanced outcomes, ongoing compliance, and reduced administrative burden. Edifecs’ automated prior authorization solution integrates with electronic health records (EHR) and leverages artificial intelligence (AI), natural language processing (NLP), and industry standards such as FHIR to instantly deliver authorization.
– This innovation comes on the heels of Edifecs’ 2021 acquisitions of Health Fidelity and Talix which expanded the company’s risk adjustment, AI and EHR integration capabilities making this fully automated prior authorization technology a reality.
AI-Driven Advances in Prior-Authorization Systems
Edifecs is a premier technology company in the US Healthcare market with solutions focused on interoperability, workflows, value-based care analytics, and payment programs. With innovative technology and solutions, Edifecs helps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of meeting various regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem. Edifecs is a frontrunner in bringing new technology for B2B data exchange in healthcare streamlining business processes from “card to care,” and reducing the industry burden associated with data provisioning at the points of enrollment, care, payment, and reporting.
With its recent acquisition of Talix and Health Fidelity, Edifecs expanded its risk adjustment business, AI technology, and EHR integration capabilities and is uniquely positioned to transform the prior authorization process. Edifecs’ solution streamlines payer and provider collaboration with automated EHR integration and data retrieval for increased efficiencies and cost savings. Edifecs prior authorization complies with existing state, federal, and all Centers for Medicare & Medicaid Services prior authorization regulations and will automatically adhere to future regulations.
“Prior authorization is one of the biggest challenges providers face today causing tension and abrasion between providers and payers,” said Venkat Kavarthapu, CEO of Edifecs. “Additionally, when patients are forced to postpone medical procedures to wait for insurance approval, the repercussions on patients’ health can be irreversible. We’re thrilled to introduce a next-generation solution that streamlines this process to ensure patients get the care they need when they need it.”
The solution delivers full payer prior authorization management workflow with tracking, monitoring, and reporting and integrates with the existing utilization management systems. Edifecs prior authorization technology also connects to the payer’s clinical guideline repository. By leveraging industry standards like FHIR and over 40 payer implementations for patient access, Edifecs’ prior authorization solution significantly reduces the time to care through EHR-agnostic integration with providers.
According to the Medical Group Management Association, prior authorization is the largest administrative burden on providers. The Council for Affordable Quality Healthcare Index reports the cost to manually process prior authorization for providers increased over 60% from $6.61 in 2018 to $10.92 in 2019. Prior authorization also continues to garner national attention as a result of the introduction of the bipartisan, bicameral, “Improving Seniors’ Timely Access to Care Act” (H.R. 8487) aimed at simplifying the prior authorization process.