What You Ought to Know:

– As we speak, Edifecs and VirtualHealth, a medical administration firm, introduced a brand new partnership automated prior authorization to VirtualHealth’s HELIOS® platform for healthcare payer and supplier shoppers.

– The Edifecs resolution 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 in the end expedite affected person care.

Rising Want for Automated Prior Authorization

In accordance to WEDI, automating prior authorization may save the medical trade $25 billion. Based mostly on consumer suggestions, VirtualHealth is including Edifecs’ prior authorization resolution to streamline prior authorizations for his or her business well being plan, ACO, residence well being, and healthcare system shoppers. 

HELIOS Overview

HELIOS is the primary cloud-native medical administration platform, purpose-built to help value-based, whole-person care. Its modern structure of utilization administration (UM) and complicated care administration (CM) inside a single ecosystem maximizes collaboration, coordination, and care supply for the whole care group. HELIOS’s configurable design and distinctive method assist get rid of information silos, simplifying UM and CM processes and lowering the necessity for IT sources.

Edifecs Automated Prior Authorization Answer

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

“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,” stated 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.”


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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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