Prior Authorization For Payers and Providers

Prior Authorization

Prior authorization is among the most significant administrative burdens providers have to manage. Prior authorization requirements can lead to strained provider–payer relationships—and, more importantly, subpar clinical outcomes for patients. A 2022 survey by the American Medical Association (AMA) found that nearly two-thirds of physicians were forced to divert to less effective medications or schedule additional office visits to satisfy prior authorization requirements.1 We believe there”s a better way.

Edifecs Prior Authorization eliminates the need for a separate prior authorization portal. Our AI-enabled solution integrates seamlessly with the provider’s EHR to deliver fully automated prior authorization at the point of care. By reducing their administrative workload, we enable providers to focus on collaborating effectively with their payer partners—and, most importantly, improving patient satisfaction and outcomes.

1 American Medical Association, 2022 AMA Prior Authorization (PA) Physician Survey.

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A Better Approach to Prior Authorization

Find out how we can help you reduce administrative workloads and improve collaboration.

Healthcare Prior Authorization 1
  • Establish real-time payer communications from your EHR
  • Automate prior authorization forms based on payer guidelines
  • Leverage NLP for more efficient and accurate data extraction

Ensure seamless collaboration

Streamline prior authorization across multiple payers—no matter what EHR you use.

Automated Prior Authorization 2
  • Remain compliant with changing federal and state guidelines
  • Reduce errors with intake and storage of updated clinical guidelines
  • Effectively manage risk exposure for all electronic guidelines

Stay up-to-date on guidelines

Connect to clinical guideline repository for greater efficiency and accuracy.

Member Prior Auth 3
  • Process unstructured chart data for more insights and faster submission
  • Reduce burden of audit, appeals, and follow-up processes
  • Seamlessly integrate with existing utilization management systems

Make better decisions—faster

Leverage AI and Machine Learning (ML) for utilization management decision support.

News & Insights

Automated Prior Authorization
Simplify prior authorization
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Fully Automate Prior Authorization at the Point of Care
An Edifecs Data Sheet: Accelerate prior authorization with an EHR integrated framework for faster automation.
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AI/NLP for Real-Time Prior Authorization for Payers & Providers
Prior authorization is one of the last unautomated business processes. That’s all about to change now that technology has evolved to a point of being an effective change agent that can solve for prior authorization like never before. By leveraging AI/NLP, FHIR® standards, and EHR integration, the path to real-time automated prior authorization from the provider’s EHR to the payer’s utilization management is finally within grasp.
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