Prior Authorization Decisions in Three Days, Not 10

How a 135-year-old, not-for-profit health system used Smart Auth Optimizer — the AI-driven prior authorization solution from ZeOmega — to automate low-risk approvals, ensure compliance, and cut Utilization Management (UM) costs.

• 70% faster turnaround — prior authorization decisions reduced from 10 days to just three
• 9% lower UM operational costs — tracked against the health system's previous UM methods
• About seven months — from implementation to go-live and ROI tracking

The Challenge: Rising UM Workloads, 10-Day Turnarounds

An extensive, integrated, not-for-profit healthcare delivery system based in the Mid-Atlantic and Southeast regions of the U.S. faced mounting UM challenges that put its 135-year record of improving health at risk:

• Rising UM workloads that delayed authorization reviews — at times forcing bulk auto-approvals just to meet service level agreement (SLA) requirements
• Prior authorization delays averaging 10 days, increasing provider dissatisfaction and negatively impacting the member experience
• No room to grow the team, with barriers preventing added workforce resources to offset the rising workload
• Escalating UM staffing costs

Inside the Case Spotlight

Download the case spotlight to see how the health system turned its UM operation around, including:

• Why it chose Smart Auth Optimizer over adding staff — and how a nearly five-year partnership with ZeOmega and the Jiva platform shaped the decision
• The UM optimization process: analyzing historical UM decisions and costs, tuning the machine learning (ML) model, and validating outputs through interactive dashboards and reports
• How low-risk requests were identified for automation — and how auto-approval rules were configured to balance ROI, compliance, and AI fairness
• The full results, from the 70% reduction in turnaround time to the 9% drop in UM operational costs.

The First End-to-End UM Optimization Package

ZeOmega is the first healthcare enterprise management organization in the U.S. to approach UM optimization this way. ZeOmega performs all the heavy lifting — data analysis, ML model building, output validation, and AI fairness support — then integrates the model output directly into Jiva as auto-approval rules, delivering a true end-to-end UM optimization package.

Ask about a demo today! To learn more, contact us at sales@zeomega.com.

Additional Resources

Press Release: ZeOmega Earns Artificial Intelligence Accreditation from DirectTrust®

Webinar: “Near Real-Time Prior Authorizations With AI”

Overview: Smart Authorization Gateway

Overview: Smart Fax Automator

Overview: Smart Auth Optimizer

Overview: Medical Guidelines Digitizer (MG Digitizer)

Overview: Medical Guidelines Assist (MG Assist)

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