ZeOmega, the industry’s leading population health management organization, announced the launch of its HealthUnity Smart Authorization Gateway (Smart Auth). It is the market’s first and only electronic prior authorization (ePA) solution that comprehensively includes EMR integration capabilities, payer/provider workflows, medical policies integration and adjudication, administrative rules and auto approval rules. Smart Auth is an end-to-end FHIR-enabled workflow for submitting ePA requests directly from providers’ EMRs to payers. It receives decisions back immediately, saving time and costs and optimizing the member/patient experience.
The prior authorization process is a well-known struggle for payers, providers, and patients – while necessary, it is tedious, time consuming and costly, and reports attribute it to 93% of delays in care. ZeOmega recognized the need to automate the prior authorization process to alleviate administrative burdens and thus created the Smart Auth Gateway. This solution takes a pragmatic approach to optimization by merging existing platforms and processes with the next-generation interoperable burden reduction framework developed under the HL7 DaVinci Project industry collaborative. Smart Auth is designed to help payers and providers roll out automation in phases while ensuring that today’s investments are aligned with the future convergence of automated ePA workflows and regulatory compliance requirements.
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“Smart Auth combines ZeOmega’s extensive utilization management workflow expertise with the interoperable FHIR-based technology framework developed through our participation as a founding member of the HL7 DaVinci Project. This solution provides tools for payers and providers together in one place with scalable interoperability that achieves faster authorizations, optimizing care,” said ZeOmega’s Vice President of Interoperability Solutions, Tony Sheng. “Smart Auth integrates with payers’ existing utilization management systems, including our Jiva platform.”
ZeOmega has collaborated with Change Healthcare and MCG to integrate the organizations’ clinical guidelines – already employed by most providers and payers – into the Smart Auth Gateway. ZeOmega is also actively working with AI-based decision support partners to automate accurate prior authorization requests and adjudication for specialty care to fast track complex service requests. The solution automates processes for various specialty review categories such as imaging, oncology and musculoskeletal, and its modular approach allows users to customize features based on their needs.
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“MCG is pleased to be working with an innovative partner like ZeOmega on a comprehensive solution that allows payers and providers to communicate with one another to expedite the authorization process to reduce the burden and improve patient outcomes,” said Rajesh Godavarthi, MCG Associate Vice President of Technology and Interoperability. “MCG and ZeOmega leverage HL7 Da Vinci Project FHIR standards in our integrated solution to provide real-time, interactive communication and automation between providers and payers. Ultimately, this enables all parties to be ahead of the curve for meeting any current and future interoperability mandates as well as provide timelier treatment to members.”
“Prior authorizations are a vital part of healthcare, but the industry needs to become more efficient,” said Andrew Johnson, vice president of Prior Authorization at Change Healthcare. “By combining our expertise in delivering and automating clinical criteria at the provider point of care with Smart Auth we will be able to bring improved efficiency and cost savings to our clients through end-to-end prior authorization automation.”
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