Real-Time Prior Authorization Provider Solutions

Provider Portal: Automated Prior Authorization Saves Significant Cost and Processing Time

Provider Benefits

  • Single point of access to all payers in provider’s network to check eligibility (270) and submit prior authorization (278) requests
  • Eliminates multiple logins to individual payer sites and automates the entire prior authorization process
  • Before submission, prior authorizations are reconciled against payer policies to reduce possibility of denials
  • Automated real-time prior authorization saves significant cost, processing time, and accelerates patient throughput
  • Simple, intuitive clinical workflow designed from the provider’s perspective
  • Accelerates revenue capture and operational cash flow
  • Fully based on the EDI 278 protocol, mandated by the ACA to be adopted by all payers January 1, 2016

Automated Referral and Prior Authorization Workflow

For Payers: Real Time 278 EDI Adjudication Engine For Prior Authorization

Payer Benefits

  • Automated prior authorization adjudication reduces cost by order of magnitude, improves response time, expands usage, and helps controls fraud
  • Significant increase in workflow efficiency, transaction volumes, time-savings, and responsiveness
  • All payers need to adjudicate prior authorization requests based on EDI 278 protocol, as mandated by the ACA by January 1, 2016
  • Advanced analytics modules help enforce appropriate use medicine and maximize outcomes per dollar spent
  • IIC’s adjudication engine solution offers all payers a more competitive product offering