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IIC’s 278 Authorization Engine enables payers to respond in real-time to the vast majority of authorization requests without human intervention, by automating all of the payer’s clinical guidelines (appropriate use criteria) used to approve or pend requests whether it be Medicare, Medicaid, MCG, InterQual, or custom guidelines. Guideline rules are editable by the payer as guidelines change or require updating.

IIC’s 278 authorization engine allows scalable utilization management and real-time adjudication based on a fully automated process. It accepts all 270/278/275 requests from any portal or system that can send 278 standard transactions.

After the PA request is processed, patient data is auto populated back into the payer’s system. There are integration points where the payer has to option to pend specific types of authorizations or requests from a specific provider for manual adjudication. Each transaction has ready access to the full history for the payer to view.

IIC’s 278 authorization engine can be integrated into any system with a well-defined API. It enables the electronic exchange of questions, requests, and documents between payer and provider using EDI 275 transaction. The goal is to eliminate all paper, fax, and phone call volumes by implementing a fully electronic authorization process.