Electronic Prior Authorization Solution: Smart Authorization Gateway
The prior-authorization process is a resource-intensive function that is essential for managing costs but which taxes workforce resources and drives member and provider abrasion.
The prior-authorization process is a resource-intensive function that is essential for managing costs but which taxes workforce resources and drives member and provider abrasion. Automating this process can yield a wide range of benefits, but the challenge has always been to build a system that differentiates between valid, routine authorization and those deserving additional scrutiny.
How Does the Jiva Platform Help with Electronic Prior Authorization?
The HealthUnity Smart Authorization Gateway applies the power of AI combined with deep experience in workflow automation and care/cost management to enable payer organizations to strike the right balance between efficiency and cost control. Utilizing an end-to-end FHIR®-enabled workflow, Smart Auth Gateway pulls relevant claims and EMR data, then applies advanced adjudication logic to either automatically generate the authorization or route the claim and associated content to the appropriate team member for human assessment.
The result is a fast and efficient system with high-pass rates and appropriate payments, saving time, cost, member satisfaction, and provider abrasion while reducing unnecessary delays in care.
Who We Serve
Commercial Health Plans
A one-stop shop for care management, benefits administration, process automation, organizational optimization, and efficiency across the enterprise.
Exceed your value-based care benchmarks leveraging combined clinical and claims data to reduce risk, close gaps, and ensure optimal outcomes.
Accountable Care Organizations
From risk-stratification to gap identification and closure strategies, our capabilities are unmatched, and built in SDOH criteria helps you reach at-risk communities with effective programs.
Medicare Advantage Plans
Built-in risk adjustment to drive consistent success in PMPM payment models and maximize Star ratings performance.
ZeOmega is #1 Best in KLAS for Payer Management Solutions 2022 and 2023
Impact of the New CMS Healthcare Interoperability Rules | ZeOmega
Much of the direction of the 2020 proposed rule is in the new proposed rule, particularly the sharing of prior authorization decisions/status with patients.
Impact of the 2023 CMS Prior Authorization Rule
Join ZeOmega’s HealthUnity team to learn how to meet providers and payers where they are today with CMS’ new proposed rule, as well as how standard FHIR and network scalability