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
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Monogram Health Secures $375M to Expand In-Home Kidney Care
What You Should Know: - Monogram Health, a Nashville, TN-based kidney disease benefit management and care delivery company announced a $375M growth funding round that will drive the company’s continued rapid expansion as the leading solution for high-quality, in-home care for polychronic patients living with chronic kidney and end-stage renal disease in the U.S. - Investors in the round include CVS Health, Cigna, Humana, Memorial Hermann Health System, SCAN, TPG Capital, Frist Cressey
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Edifecs Partners with Empowered-Home to Deliver Automated Prior Authorizations
What You Should Know: - Edifecs and Empowered-Home announced a partnership to provide automated prior authorizations to medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home health care agencies. - The Edifecs prior authorization solution combined with the clinical decision support system of patient management software company, Privis Health, forms the backbone of Empowered-Home’s ecosystem. Empowered-Home is
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Edifecs Launches Solution to Automate Prior Authorization at the Point of Care
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
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HealthTeam Advantage Integrates With Bamboo Health’s Pings Solution
What You Should Know: - Bamboo Health™ recently announced that HealthTeam Advantage (HTA), the business name of Care N’ Care Insurance Company of North Carolina, Inc., has integrated Bamboo Health’s Pings™ solution. - The Pings rollout delivers real-time admission, discharge, and transfer (ADT) e-notifications for HTA’s 15,000 North Carolina PPO and HMO Medicare Advantage plan members. Using Real-Time E-Notifications to Lower Costs and Improving High Quality Care Bamboo Health
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Apixio Launches Real-Time Health Data Management Solution
What You Should Know: - Apixio, today, announced the launch of Apicare ChartSpace™, a health data management solution that provides real-time data access to centralized medical charts, accelerated chart and audit file retrieval, and enables the surfacing of actionable insights across value-based care programs. - Apicare ChartSpace centralizes health data, improves security and efficiency of data sharing across departments and external partners, and powers Apixio’s AI-Driven
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Geisinger Taps Cohere Health to Streamline Prior Authorizations
What You Should Know: - Today Geisinger Health Plan (GHP) and Cohere Health, a provider of utilization management (UM) technology, announced they are joining forces to streamline the prior authorization process for providers. - Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of business, including
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Why Health Plans Must Have Next-Gen CAPS Technology for Digital Transformation
Core Administrative Processing Systems (CAPS) operate as the brains behind a health plan’s business. These systems are critical to the smooth functioning of a health plan. Today, many payers run on decades-old CAPS systems built on legacy technologies. This can be a serious drawback. Legacy systems may have been efficient based on the technology and best practices of decades past, but have aged beyond their time. They often require an increasing number of workarounds and fixes to try to
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GuideWell Becomes First U.S. Payer to Automate Prior Authorizations
What You Should Know: - GuideWell, one of the 10 largest health insurance providers in the U.S., became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews from Olive, resulting in faster care for patients — up to 10 days faster — and greater provider satisfaction. - After launching a pilot with Olive in Florida, GuideWell saw its time to decision reduced by 10 days when immediate responses were available, decreased unnecessary prior
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XSOLIS Raises $75M for AI-Driven Precision Utilization Management Platform
What You Should Know: - XSOLIS, a healthcare technology firm focused on improving healthcare operations announced it has raised $75M in minority growth investment from Brighton Park Capital ("Brighton Park"), a research-driven investment firm. - XSOLIS is an artificial intelligence-based software platform that helps national health systems and payers streamline the utilization management process. - XSOLIS' suite of data-driven solutions leverages insights from proprietary machine
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