Claims Acceleration Suite
Prior Authorization
Streamline health insurance and prior authorization claims processing by transforming data and enabling experts to make faster, more informed decisions.
Overview
Improve efficiency by streamlining processes
Our AI-enabled solution accelerates time-to-decision, improving access to care, and elevates physician experience, all while reducing data processing errors and costs.
Reduce administrative burden and physician burnout
Empower providers to focus more on patient outcomes as they can spend less time on obtaining medical necessity review and are able to align on treatments faster. Through an expedited clinical review process, providers can redeploy clinical resources on care management and help ease workloads for physicians.
Expedite prior authorization decisioning
Enable insights and analytics across the organization for faster data-driven decision-making.
How It Works
Claims Acceleration Suite expedites prior authorization submission and review processes by transforming unstructured data from documents into structured datasets.
In addition to transforming data in FHIR for near real-time payer/provider data exchange, it enables enterprises to make faster, data-driven decisions through analytics and insights.
The solution consists of three components: Prior Authorization Submission, Claims Data Activator, and Prior Authorization Review.
Common Uses
Prior Authorization Submission
Myndshft, built on Google Cloud technology, helps providers determine if health plans require prior authorization approval for medical orders.
If prior authorization is needed, the solution populates the request with necessary patient clinical and demographic information from the EMR and prepares a prior authorization request for submission to the health plans. This component consists of an application and API to enable quick and seamless submission of the prior authorization request.
How-tos
Myndshft, built on Google Cloud technology, helps providers determine if health plans require prior authorization approval for medical orders.
If prior authorization is needed, the solution populates the request with necessary patient clinical and demographic information from the EMR and prepares a prior authorization request for submission to the health plans. This component consists of an application and API to enable quick and seamless submission of the prior authorization request.
Claims Data Activator
Store and serve data for prior authorization determination and review with Claims Data Activator.
Claims Data Activator facilitates the interoperable exchange of standardized information between provider and payer systems, ingests prior authorization forms and medical documents in Cloud Storage, and extracts essential data elements using Document AI and Healthcare NLP API. The extracted data can then be stored as structured data in BigQuery, Firestore, and Cloud Healthcare API (FHIR data store).
How-tos
Store and serve data for prior authorization determination and review with Claims Data Activator.
Claims Data Activator facilitates the interoperable exchange of standardized information between provider and payer systems, ingests prior authorization forms and medical documents in Cloud Storage, and extracts essential data elements using Document AI and Healthcare NLP API. The extracted data can then be stored as structured data in BigQuery, Firestore, and Cloud Healthcare API (FHIR data store).
Prior Authorization Review
Expedite manual review of prior authorization requests by supporting the human-based workflow using Pega Care Management Application, now available on Google Cloud Marketplace.
How-tos
Expedite manual review of prior authorization requests by supporting the human-based workflow using Pega Care Management Application, now available on Google Cloud Marketplace.
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Get started with our AI-enabled Claims Acceleration Suite
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