The Prior Authorization System is fully compliant with all state and federal laws and provides multiple features designed to simplify documentation and improve the prior authorization process.
With an easy to use interface we integrate a wide variety of technologies to stream line prior authorization the document engines provides for diverse language support Spanish, Korean, Chinese, Vietnamese, Farsi and more. We integrate fax services and web services for submissions and external web services (like Argus) for verification of eligibility authorizations and claims.
To ensure the maximum level of service and compliance and adherence to federal and state regulations there is extended time management features which can be enabled for each health plan providing for a variety of compliance requirements.
This system supports Member Transition and generates the appropriate documents for both the Member and Provider in multiple languages and templates preferred by the Plan.
The application leverages the latest technologies and is continually enhanced to support the ever changing landscape of Healthcare Services supporting a mobile interface for both IPad/IPhone and Android tablets/phones.
Reporting provides for both high level executive summaries and deep dive compliance centric outputs.
Auditing is extensive monitoring every step of the prior authorization workflow (approval, denial, partial approval, medical review etc.) from order receipt to closure.