Elevance Health Makes Clinical Review Faster, More Connected with Health OS

INDIANAPOLIS--(BUSINESS WIRE)--Elevance Health today announced advancements in how it helps streamline clinical review and create a simpler, faster, and more connected experience for care providers and members through Health OS.

Health OS is Elevance Health’s secure data platform designed to connect health information across electronic health records (EHRs), labs, and health information exchanges, helping support more informed and timely clinical decisions while reducing administrative burden for care providers. By connecting with healthcare data systems, including Epic’s Payer Platform, Health OS helps reduce manual steps and deliver clearer clinical insights.

“Health OS represents a foundational shift in how we approach clinical review and utilization management - moving from fragmented, manual processes to a connected, intelligent ecosystem,” said Ashok Chennuru, Chief Data and Digital Transformation Officer at Elevance Health. “We are enabling faster decisions, reducing administrative burden, and improving the overall care experience by applying advanced analytics and embedding data-driven insights directly into workflows between care providers, payers, and other partners.”

Elevance Health was the first to collaborate with Epic in leveraging the Epic Payer Platform in addressing inpatient concurrent reviews, where payers and providers work together to review care plans during a patient’s hospital stay. These reviews help support appropriate treatment and length-of-stay decisions but have historically relied on manual submission of clinical documentation, often resulting in delays, incomplete information, and additional administrative work.

Early results from health systems using Health OS-enabled workflows demonstrate meaningful improvements:

• A 61% reduction in prior authorization denials due to insufficient clinical information
• Nearly 60% fewer cases designated pending because of the need for additional information
• Up to a 51% reduction in follow-up reviews, including appeals and peer-to-peer discussions, driven by more complete information upfront
• Approximately 15 minutes of administrative time saved per case with some health systems
• Care providers report a more transparent and efficient process, with fewer documentation requests, faster alignment on care decisions, and more time to focus on patient care

Health OS is also transforming prior authorization through electronic prior authorization for medical services by making it part of provider workflows and allowing information to be appropriately and securely shared back and forth between providers and the health plan. This significantly reduces reliance on phone, fax, and paper submissions, while improving speed and consistency.

With more than 30 health systems actively participating in Elevance Health’s program for electronic prior authorization for medical services, results highlight the impact of this approach:

• More than 250,000 prior authorization requests for medical services processed in 2026 through end of April
• Of these, more than 42% of decisions completed in one minute or less

For providers, this means reduced administrative burden and a more intuitive, streamlined experience that aligns with existing workflows. For members, it translates to faster access to approved treatments and a more predictable care journey.

“Much of the waste and complexity in healthcare could be reduced by simply making the right information available to the right stakeholders,” said Alan Hutchison, Vice President at Epic. “Through our work with Elevance Health, Epic’s Payer Platform has enabled meaningful reductions in administrative burden with measurable reductions in denials, peer-to-peer reviews, and appeals. This means less work for providers and faster access to care for patients.”

Elevance Health is focused on expanding its capabilities, advancing a future where utilization management is faster, simpler, and more aligned with patient care. Health OS reflects Elevance Health’s broader commitment to simplifying the healthcare experience for consumers and helping to improve health outcomes.

About Elevance Health

Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company supports consumers, families, and communities across the entire healthcare journey – connecting them to the care, support, and resources they need to lead better lives. Elevance Health’s companies serve approximately 105 million consumers through a diverse portfolio of industry-leading medical, pharmacy, behavioral, clinical, home health, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on X and Elevance Health on LinkedIn.