Leveraging AI and NLP from recent acquisitions and FHIR® standards, Edifecs and Empowered-Home provide automated prior authorization in real-time
BELLEVUE, Wash., November 16, 2022--(BUSINESS WIRE)--Edifecs, Inc., a global health information technology solutions company and Empowered-Home, today announced a partnership to provide automated prior authorization to medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home health care agencies. Empowered-Home has added Edifecs’ prior authorization solution to its unique partner ecosystem using virtual care management at its core to help ACOs, IPAs, and health plans achieve clinical and financial success as the industry transitions to remote value-based care. The Edifecs prior authorization solution combined with the clinical decision support system of patient management software company, Privis Health, forms the backbone of Empowered-Home’s ecosystem.
Empowered-Home is connected with medical associations in multiple states including New York, Texas, Washington, Montana, and Hawaii because it is a complex ecosystem that requires cooperation from both sides.
"As strong supporters of the ‘Improving Seniors’ Timely Access to Care Act,’ we are proud to be partnering with Empowered-Home to automate the prior authorization process for its customers and partners, and ultimately provide seniors with more timely access to care," said Venkat Kavarthapu, CEO of Edifecs. "The prior authorization process is cumbersome and costly for both payers and clinicians. We have worked hard to alleviate that burden by automating it from the provider’s EHR system to the payer’s utilization management workflow."
Edifecs’ automated prior authorization solution is built on its proven interoperability platform used by hundreds of customers that serve more than 215 million people. It leverages artificial intelligence, natural language processing, and industry standards such as FHIR® to instantly deliver authorizations. The solution streamlines payer and provider collaboration with automated electronic health record (EHR) integration and data retrieval for increased efficiencies and cost savings. Edifecs’ prior authorization solution complies with existing state, federal, and all Centers for Medicare & Medicaid Services prior authorization regulations, and will automatically adhere to future regulations.
"Our mission is to help people age in place with dignity, choice, and independence through a continuous quality of care program that blends virtual patient care with the familiarity of trusted personalized care," said Walt Pistor, CEO of Empowered-Home. "By combining Edifecs’ technology with Privis Health’s clinical decision support system, we are able to fully automate the prior authorization process from end-to-end at the point of care while lowering burdensome administrative tasks. It also enables physicians to accelerate the speed at which they can provide necessary care and improve patient outcomes."
The Edifecs prior authorization solution provides real-time adjudication resulting in more accurate billing, fewer claim denials, and faster reimbursement. Additionally, it significantly decreases the administrative burden on providers allowing them to focus more time on patient care and alleviate physician burnout.
The burden of the prior authorization process is approximately 16 hours per week or $80,000 per ordering physician per year. The delay in treatment is often over 30 days and can cause a significant detriment to the care regime and patient health.
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Edifecs is a premier technology company in the US Healthcare market with solutions focused on interoperability, workflows, value-based care analytics, and payment programs. With innovative technology and solutions, Edifecs helps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of meeting various regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem. Edifecs is a frontrunner in bringing new technology for B2B data exchange in healthcare streamlining business processes from "card to care," and reducing the industry burden associated with data provisioning at the points of enrollment, care, payment, and reporting. With the advent of FHIR and new regulatory guidance from HHS, Edifecs has emerged as a leader in easing the effort associated with achieving compliance with new federal rules and in making the healthcare consumer the primary stakeholder. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia, San Francisco, California, and Mohali, India, an engineering center in Moldova, Belarus and Ukraine, and has more than 1,000 employees.
Empowered-Home is an innovative and forward-thinking company comprised of highly-experienced subject matter experts in the field of digital healthcare ecosystems. The company has built a unique partner ecosystem connecting patients with providers (including home care), to payers and self-insured companies leveraging a proactive "continuous quality of care" program that unites the latest in virtual care management (VCM) with traditional telemedicine. It supports physican reimbursement for Value-Based Care including Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), fall prevention, telemedicine, and automated prior authorization. It differentiates itself by using AI and NLP in their solutions to automate time consuming processes at a lower error rate and by gaining proactive insight into each patient’s status and health progress including patient awareness and education. Building and revising automated patient care plans is just one part of what Empowered-Home does, and the company hasn’t forgotten that technology must be combined with the human touch of virtual nurses and homecare providers to truly enhance patient compliance, adherence, and trust.
Empowered-Home has offices in San Jose, California; New Haven, Connecticut; Dallas, Texas; and Atlanta, Georgia.
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