BOSTON--(BUSINESS WIRE)--Harvard Pilgrim Health Care, Inc. (HPHC) and New England Health Exchange Network (NEHEN) deployed Informatics In Context’s (IIC) EDI 278 real-time prior authorization engine in limited production, automating HPHC’s prior authorization process today. Selected provider groups are now able to submit prior authorization requests for approval and receive instant actionable responses in seconds without human intervention.
IIC's real-time adjudication of prior authorizations enables HPHC and NEHEN to approve, pend, or deny provider requests based on the plan’s clinical and business criteria. IIC’s scalable and automated utilization review solution allows HPHC and NEHEN to improve service quality for their providers, reduce errors, while providing the most effective method for medical oversight and compliance.
In its initial deployment, providers submit authorization requests for the chosen medical procedures, home health services, and specialty drugs. Responses to providers for documentation, attachments, or questions are handled electronically using the EDI 275 daughter transaction, making the entire adjudication process completely touchless. Full production deployment is anticipated in Q1’17.
“Fully automating our plans' authorization adjudication process will allow us to minimize the hassle, time, and expense of the current authorization review process. This innovative approach being led by HPHC is a large step forward for greater efficiency and improved provider and member satisfaction,” states Dave Delano, Executive Director of NEHEN.
“NEHEN and HPHC are leading the way for the industry, proving that a fully automated prior authorization process is now possible and real,” states Vikram Simha, President and CEO at Informatics In Context.