For Providers:

Informatics In Context’s provider portal or integrated web service automates today’s manual process when submitting prior authorization requests to all payers within the provider’s network. IIC’s provider portal is a single point of access for all payers within the providers network to check eligibility (based on EDI 270), and submit prior authorizations (based on EDI 278) without needing to access and login to individual payer sites each time. Before submission, prior authorization requests are reconciled against the payer’s policy guidelines to ensure compliance and reduce denials.

For Payers:

Informatics In Context’s real-time EDI 278 engine adjudicates all incoming prior authorization requests based on the payer’s policy guidelines and-or evidence-based medicine.In addition, IIC’s advanced analytics modules helps enforce appropriate use medicine to maximize outcomes per dollar spent. Our analytics module can take a set of submitted indications (ICD codes, patient history, patient demographics, etc.) and look up Appropriate Use Criteria to recommend cost saving alternate clinical options to help payers ensure compliance. Other analytic triggers can reduce cost based on fraud alerts, analyze provider submission patterns, procedure selection patters, real-time calculation of incurred costs and much more. All payers require a real-time adjudication solution for prior authorization based on the ACA mandate of January 1, 2016. IIC’s engine is the first commercial solution fully based on the EDI 278 protocol standard.