June 10, 2023

BELLEVUE, Wash.–(Business enterprise WIRE)–Edifecs, Inc., a world health and fitness details engineering methods firm, these days announced a new answer that entirely automates prior authorization at the place of care, top to enhanced member encounters, enhanced results, ongoing compliance, and lessened administrative load. Edifecs’ automatic prior authorization alternative integrates with electronic wellness records (EHR) and leverages artificial intelligence (AI), all-natural language processing (NLP), and marketplace requirements this kind of as FHIR to instantly supply authorization.

With its modern acquisition of Talix and Health and fitness Fidelity, Edifecs expanded its danger adjustment enterprise, AI technological innovation, and EHR integration abilities and is uniquely positioned to transform the prior authorization process. Edifecs’ solution streamlines payer and supplier collaboration with automated EHR integration and data retrieval for amplified efficiencies and price tag financial savings. Edifecs prior authorization complies with present condition, federal, and all Facilities for Medicare & Medicaid Solutions prior authorization rules and will routinely adhere to long term laws.

“Prior authorization is 1 of the biggest problems vendors experience now triggering pressure and abrasion between suppliers and payers,” mentioned Venkat Kavarthapu, CEO of Edifecs. “Additionally, when sufferers are pressured to postpone medical strategies to wait for insurance policies acceptance, the repercussions on patients’ health can be irreversible. We’re thrilled to introduce a subsequent-generation resolution that streamlines this process to guarantee patients get the care they want when they require it.”

The option provides full payer prior authorization management workflow with monitoring, checking, and reporting and integrates with the current utilization administration programs. Edifecs prior authorization technologies also connects to the payer’s medical guideline repository. By leveraging market specifications like FHIR and in excess of 40 payer implementations for affected individual accessibility, Edifecs’ prior authorization resolution drastically cuts down the time to treatment via EHR-agnostic integration with providers.

“Payers experience elaborate worries processing prior authorization requests. Our objective-constructed solution is made to relieve provider friction and simplify the procedure with automatic, agnostic EHR integration, info retrieval, and crafted-in regulatory compliance,” continued Kavarthapu.

In accordance to the Health care Team Administration Association, prior authorization is the premier administrative stress on providers. The Council for Affordable Quality Healthcare Index experiences the charge to manually procedure prior authorization for suppliers amplified above 60% from $6.61 in 2018 to $10.92 in 2019. Prior authorization also continues to garner nationwide consideration as a consequence of the introduction of the bipartisan, bicameral, “Improving Seniors’ Timely Accessibility to Care Act” (H.R. 8487) aimed at simplifying the prior authorization process.

To master extra about Edifecs prior authorization, remember to visit: https://www.edifecs.com/solutions/prior-authorization

About Edifecs

Edifecs is a premier engineering organization in the US Healthcare current market with remedies focused on interoperability, workflows, value-centered care analytics, and payment courses. With impressive technological innovation and methods, Edifecs can help its shoppers by optimizing the protected trade and processing of administrative and clinical information, decreasing the charge of conference various rules, and automating workflows included in many core procedures in just the health care ecosystem. Edifecs is a frontrunner in bringing new technological know-how for B2B info exchange in health care streamlining small business processes from “card to treatment,” and decreasing the business burden associated with info provisioning at the factors of enrollment, care, payment, and reporting. With the advent of FHIR and new regulatory guidance from HHS, Edifecs has emerged as a chief in easing the work linked with achieving compliance with new federal principles and in making the healthcare customer the primary stakeholder. The company is headquartered in Bellevue, Washington, with supplemental offices in Atlanta, Georgia, San Francisco, California, and Mohali, India, engineering facilities in Moldova, Belarus and Ukraine, and has extra than 1,000 employees.