• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to secondary sidebar
  • Skip to footer

  • Opinion
  • Health IT
    • Behavioral Health
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Patient Engagement
    • Population Health Management
    • Revenue Cycle Management
    • Social Determinants of Health
  • Digital Health
    • AI
    • Blockchain
    • Precision Medicine
    • Telehealth
    • Wearables
  • Life Sciences
  • Investments
  • M&A
  • Value-based Care
    • Accountable Care (ACOs)
    • Medicare Advantage

Edifecs and VirtualHealth Partner to Automate Prior Authorization

by Fred Pennic 02/01/2023 Leave a Comment

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

What You Should Know:

– Today, Edifecs and VirtualHealth, a medical management company, announced a new partnership automated prior authorization to VirtualHealth’s HELIOS® platform for healthcare payer and provider clients.

– The Edifecs solution will automate and optimize the prior authorization process across HELIOS to significantly reduce the administrative burden, alleviate friction between payers and providers, and ultimately expedite patient care.

Growing Need for Automated Prior Authorization

According to WEDI, automating prior authorization could save the medical industry $25 billion. Based on client feedback, VirtualHealth is adding Edifecs’ prior authorization solution to streamline prior authorizations for their commercial health plan, ACO, home health, and healthcare system clients. 

HELIOS Overview

HELIOS is the first cloud-native medical management platform, purpose-built to support value-based, whole-person care. Its innovative architecture of utilization management (UM) and complex care management (CM) within a single ecosystem maximizes collaboration, coordination, and care delivery for the entire care team. HELIOS’s configurable design and unique approach help eliminate data silos, simplifying UM and CM processes and reducing the need for IT resources.

Edifecs Automated Prior Authorization Solution

Edifecs’ automated prior authorization solution is built on its proven interoperability platform used by hundreds of customers, processing healthcare data for more than 290 million people. It leverages artificial intelligence, natural language processing, and industry standards such as FHIR® to instantly deliver authorizations. The solution streamlines payer and provider collaboration with automated electronic health record (EHR) integration and data retrieval to reduce the resource burden, and increase efficiencies and cost savings. Edifecs’ prior authorization solution complies with existing state, federal, and all Centers for Medicare & Medicaid Services prior authorization regulations and will automatically adhere to future regulations.

“The prior authorization process is a tremendous burden across our healthcare system impacting both payers and clinicians. For more than two decades we have helped eliminate friction between payers and providers, giving us deep insight into their workflows, data sets, and business and administrative processes,” said Venkat Kavarthapu, CEO, Edifecs. “This enabled our team to build an intelligent automated solution that significantly reduces the burden of prior auth, expediting patient care and reducing the drain on cost and resources for payers and providers alike.”

  • LinkedIn
  • Twitter
  • Facebook
  • Email
  • Print

Tagged With: ACO, Artificial Intelligence, care management, cloud, Edifecs, Electronic Health Record, FHIR, Healthcare Data, home health, interoperability, medicaid, medicare, Patient Care, Payers, Prior Authorization, Revenue Cycle Management, Utilization Management, VirtualHealth, WEDI

Tap Native

Get in-depth healthcare technology analysis and commentary delivered straight to your email weekly

Reader Interactions

Primary Sidebar

Subscribe to HIT Consultant

Latest insightful articles delivered straight to your inbox weekly.

Submit a Tip or Pitch

Featured Insights

Digital Health Funding Q3 2025: Choppy Undercurrents Beneath a Steady Surface

Most-Read

Qualtrics Acquires Press Ganey Forsta for $6.75B to Create the Most Comprehensive AI Experience Platform

Qualtrics Acquires Press Ganey Forsta for $6.75B to Create the Most Comprehensive AI Experience Platform

Pfizer and Trump Administration Announce Landmark Agreement to Lower Drug Costs

Pfizer and Trump Administration Announce Landmark Agreement to Lower Drug Costs

KLAS Report: Epic's Native Ambient Speech Tool Reshapes Customer AI Strategies

KLAS Report: Epic’s Native Ambient Speech Tool Reshapes Customer AI Strategies

Epic Unveils MyChart Central and New APIs to Advance Interoperability at Open@Epic

Epic Outlines Roadmap for Next-Generation Data Sharing at Open@Epic

Epic Launches Comet: A New AI Platform to Predict Patient Health Journeys

Epic Launches Comet: A New AI Platform to Predict Patient Health Journeys

RevSpring to Acquire Kyruus Health, Creating a Unified Patient Experience

RevSpring to Acquire Kyruus Health, Creating a Unified Patient Experience

Oracle Confirms Layoffs in Kansas City

Oracle Confirms Layoffs in Kansas City

Philips Future Health Index 2025: AI and Digital Tech Can Help Solve Cardiac Care Crisis

Philips Future Health Index 2025: AI and Digital Tech Can Help Solve Cardiac Care Crisis

Optain Health Secures $26M to Advance AI-Powered Retinal Screening

Optain Health Secures $26M for AI-Powered Retinal Screening

Sutter Health and Epic Launch "Sutter Sync" to Optimize Remote Chronic Care

Sutter Health and Epic Launch “Sutter Sync” to Optimize Remote Chronic Care

Secondary Sidebar

Footer

Company

  • About Us
  • Advertise with Us
  • Reprints and Permissions
  • Submit An Op-Ed
  • Contact
  • Subscribe

Editorial Coverage

  • Opinion
  • Health IT
    • Care Coordination
    • EMR/EHR
    • Interoperability
    • Population Health Management
    • Revenue Cycle Management
  • Digital Health
    • Artificial Intelligence
    • Blockchain Tech
    • Precision Medicine
    • Telehealth
    • Wearables
  • Startups
  • Value-Based Care
    • Accountable Care
    • Medicare Advantage

Connect

Subscribe to HIT Consultant Media

Latest insightful articles delivered straight to your inbox weekly

Copyright © 2025. HIT Consultant Media. All Rights Reserved. Privacy Policy |