Leveraging AI and NLP from latest acquisitions and FHIR requirements, Edifecs and VirtualHealth present automated prior authorization in real-time

Edifecs, a worldwide well being info know-how options firm and VirtualHealth, an industry-leading medical administration know-how firm, at the moment introduced a partnership to present automated prior authorization to VirtualHealth’s HELIOS platform for healthcare payer and supplier shoppers.

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“This enabled our team to build an intelligent automated solution that significantly reduces the burden of prior auth, expediting patient care and reducing the drain on cost and resources for payers and providers alike.”

The Edifecs answer will automate and optimize the prior authorization course of throughout HELIOS to considerably cut back the executive burden, alleviate friction between payers and suppliers, and finally expedite affected person care. In accordance to WEDI, automating prior authorization may save the medical {industry} $25 billion. Based mostly on shopper suggestions, VirtualHealth is including Edifecs’ prior authorization answer to streamline prior authorizations for their industrial well being plan, ACO, house well being, and healthcare system shoppers.

HELIOS is the primary cloud-native medical administration platform, goal constructed to help value-based, whole-person care. Its revolutionary structure of utilization administration (UM) and complicated care administration (CM) inside a single ecosystem maximizes collaboration, coordination, and care supply for the complete care staff. HELIOS’s configurable design and distinctive method helps eradicate knowledge silos, simplifying UM and CM processes and lowering the necessity for IT assets.

“The prior authorization process is a tremendous burden across our healthcare system impacting both payers and clinicians. For more than two decades we have helped eliminate friction between payers and providers, giving us deep insight into their workflows, data sets, and business and administrative processes,” mentioned Venkat Kavarthapu, CEO, Edifecs. “This enabled our team to build an intelligent automated solution that significantly reduces the burden of prior auth, expediting patient care and reducing the drain on cost and resources for payers and providers alike.”

“Prior authorization has been a burdensome issue across the industry and is a pain point we hear about from many of our clients,” mentioned Adam Sabloff, Founder and CEO of VirtualHealth. “Offering a streamlined prior auth process will help HELIOS users improve patient care experiences and outcomes, and to transform the healthcare system for the betterment of all. We’re very pleased to be able to partner with Edifecs to bring their electronic prior auth solution to HELIOS users.”

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Edifecs’ automated prior authorization answer is constructed on its confirmed interoperability platform utilized by lots of of shoppers, processing healthcare knowledge for greater than 290 million folks. It leverages synthetic intelligence, pure language processing, and {industry} requirements akin to FHIR® to immediately ship authorizations. The answer streamlines payer and supplier collaboration with automated digital well being report (EHR) integration and knowledge retrieval to cut back the useful resource burden, and improve efficiencies and value financial savings. Edifecs’ prior authorization answer complies with present state, federal, and all Facilities for Medicare & Medicaid Providers prior authorization rules and will routinely adhere to future rules.

The Facilities for Medicare & Medicaid Providers lately issued a proposed rule to cut back the burden prior authorization locations on payers, suppliers, and sufferers. Moreover, the {industry} expects the vast majority of states are planning prior authorization regulation in 2023.

The Edifecs prior authorization answer gives real-time adjudication leading to extra billing, fewer declare denials, and sooner reimbursement. Moreover, it considerably decreases the executive burden on suppliers permitting them to focus extra time on affected person care and alleviate doctor burnout.

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The Obsessed Guy
Hi, I'm The Obsessed Guy and I am passionate about artificial intelligence. I have spent years studying and working in the field, and I am fascinated by the potential of machine learning, deep learning, and natural language processing. I love exploring how these technologies are being used to solve real-world problems and am always eager to learn more. In my spare time, you can find me tinkering with neural networks and reading about the latest AI research.


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