Prior Authorization For Payers and Providers

Prior Authorization

Ensure seamless collaboration between payers and providers

Prior authorization is among the most significant administrative burdens in healthcare. The complexities of the prior authorization process often lead to strained provider-payer relationships and subpar clinical outcomes for patients. And that leads to increased provider workloads and higher costs for health plans.  

Edifecs’ Prior Authorization solution helps alleviate that burden by eliminating the need for a separate prior authorization portal. Our cloud-native, AI-enabled solution integrates seamlessly with provider EHRs to deliver fully automated end-to-end prior authorization at the point of care while ensuring compliance with regulatory mandates. Our Prior Authorization solution reduces administrative workloads to help health plans and providers collaborate more effectively, remove prior authorization hurdles—and most importantly, deliver better experiences and outcomes for patients and members. 

How much would you save by automating your prior authorization processes?

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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
integrate
  • Establish real-time communications between the payer and provider through the EHR
  • Automate prior authorization forms based on payer guidelines
  • Leverage NLP for more efficient and accurate data extraction

Ensure seamless collaboration

Streamline prior authorization workflows across multiple EHRs and systems.

Automated Prior Authorization 2
facilitate
  • 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 mandates

Ensure ongoing compliance in an evolving regulatory landscape.

Member Prior Auth 3
utilize
  • Process unstructured chart data with our NLP engine 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

Preparing for CMS-0057-F Interoperability and Prior Authorization Rule
Preparing for CMS-0057-F Interoperability and Prior Authorization Rule
CMS-0057-F, the prior authorization and interoperability rule, is now final. Edifecs explains what it means and what you need to do to comply.
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Prior Authorization: Payer, Provider, and Patient Impact
Edifecs Product Manager Brian Poteet shares his perspective on the impact of CMS-0057-F on prior authorizations for payers, providers, and patients.
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Automated Prior Authorization Technologies Blog
Solving for Automated Prior Authorization: Three Things You Need to Know
Learn how to solve for real-time prior authorization and evolving legislation.
Learn More  ❯
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