Best Government Prior Authorization Software

Service Center by Office Ally is a trusted revenue cycle management platform used by over 65,000 healthcare organizations processing more than 350 million claims annually. With it, providers can verify patient eligibility and benefits, upload and submit claims, correct rejected claims, check claim status, and obtain remits. With multiple claim types and submission options, providers can easily submit claims to any payer from any practice management system. Transactions are secure, ensuring the confidentiality of sensitive patient information. With no needed implementation, providers can quickly and effortlessly streamline their billing processes, increase their financial performance, simplify medical billing, and reduce claim rejections for faster reimbursements.

EHR 24/7 by Office Ally is a trusted electronic health record system used by more than 20,000 users. Its comprehensive patient charting and document management, real-time patient information, and customizable forms provide healthcare providers with an intuitive interface to manage patient care. By using EHR 24/7, providers can improve communication and collaboration between providers, leading to more accurate diagnoses and fewer errors. Its seamless integration with other Office Ally solutions also provides additional functionality such as patient intake, electronic prescription and more. With no needed implementation, healthcare providers can use EHR 24/7 to treat and document patients today. ALL-IN-ONE EHR SOLUTION Manage patient records and appointment scheduling in one powerful and intuitive platform. AFFORDABLE PRICING Get an EHR system that fits your budget, whether large or small. PHYSICIAN-APPROVED EHR 24/7 is used and trusted by more than 20,000 users

RXNT's integrated, cloud-based Electronic Health Records (EHR) software with E-Prescribing and Patient Portal optimizes patient care and streamlines workflows for practices of all specialties and sizes. Providers can access up-to-date patient health and prescription history using a single database, from any device. With integrated communications, providers can share real-time clinical data with patients and clinicians for better care coordination and next step support. Intake forms and "smart" keys enhance customization and eliminate redundancy. Your practice will benefit from the ease of the Patient Check-In feature, as well as integrated Electronic Prescribing (eRx). HIPAA compliant, ONC-certified, EPCS-certified, and satisfies MACRA/MIPS requirements. RXNT also offers Practice Management (PM) with Medical Billing and Scheduling and standalone E-Prescribing. Pick a solution a-la-carte with predictable pricing, or implement our Full Suite for a single, integrated platform.

Practice Mate by Office Ally is a HIPAA-compliant practice management solution that simplifies revenue cycle management, reporting, billing, and streamlined booking to increase efficiency in your practice. Get started today at no cost to reduce unnecessary administrative tasks, enhance job satisfaction, and improve the overall patient experience.

Azalea Health Innovations (Azalea) is changing the way health IT platforms connect community-based healthcare providers and patients across the care continuum. Offering a 100% cloud-based, interoperable solution, Azalea delivers an electronic health record that is fully integrated with telehealth, revenue cycle management, and analytic solutions designed for rural, community, and urban practices and hospitals. Quick to deploy and intuitive to use, Azalea's EHR ensures better care coordination and communication, and the “one patient, one record” approach provides care teams the agility to achieve better outcomes. The Azalea platform also delivers tools and resources to help providers meet their Meaningful Use requirements, and informs their strategies to navigate accountable care and alternative payment models.

For providers, medical necessity denials cost thousands to millions of dollars every year in write-offs, plus costly staff time researching and appealing denials and responding to patient concerns. For payers, the same is true on the other end of the claim management spectrum: Paying for medically unnecessary procedures and treatments – and time spent working on denial appeals – raises costs without improving outcomes. And of course, for the patient, there can be unnecessary copays and other out-of-pocket costs, not to mention a poor patient experience involving costs and moments of care they did not need. ABN Assistant™ from Vālenz® Assurance delivers the prior authorization tools providers need to validate medical necessity, print Medicare-compliant ABNs with estimated cost, and stop over 90 percent of medical necessity denials by verifying necessity before care is delivered to the patient.

MedicsRIS is a comprehensive radiology information system that empowers radiologists to seamlessly manage their practice and easily get paid for every diagnostic exam. Developed by Advanced Data Systems, MedicsRIS takes inbound orders from referring physician’s stage 2 certified electronic medical record (EMR) without any costly HL7 interfaces as well as obtain incentives and avoid penalties. Core features of MedicsRIS that help boost business productivity include a referring physicians portal, automated billing with EDI, multi-modality scheduling, insurance eligibility verification, mammography tracking, and more. Give referring physicians and radiology departments access to our qualified CDS option via the MedicsRIS portal for those who don’t have their own qCDSM. Stymied with getting prior authorizations manually? Our automated PA option gets them online without leaving MedicsRIS.

We’re accelerating innovative solutions created to benefit all stakeholders in healthcare, to help increase speed to therapy, reduce prescription abandonment and support improved health outcomes for the patient. We’re committed to removing access barriers to healthcare — whether it’s resolving prior authorization requests or raising awareness around support services. Healthcare is seemingly more expensive than ever. Assist your patients in getting their prescribed therapy with affordability solutions that help with high-deductible health plans, increasing copays and a lack of visibility. For some, staying on therapy can be the hardest part of their healthcare journey — whether it’s learning how to take their medications or simply remembering to do it at the prescribed time. Which is why these adherence challenges must be met with people-first solutions.

MDToolbox-Rx is a Certified, Award-Winning, complete electronic prescription writer that can run stand-alone or synced with your other office software. The e-Prescribing Software is a highly customizable, simple to use e-prescribing system that allows you to easily select drugs, find drug information, and create and electronically send a prescription quickly and efficiently. MDToolbox-Rx is Certified for e-Prescribing, Eligibility, Formulary, EPCS (e-Prescribing of Controlled Substances), and Electronic Prior Authorization. Search for drugs by name, nickname, generic, brand, rx, OTC, class or indication in the most comprehensive drug database available. Higher productivity due to less pharmacy calls and time spent for renewal requests.

PracticeAdmin Scheduling reduces no-shows and improves your patient interactions by providing the data you need on demand. Using our proprietary rules-based architecture, you can set up your own preferences — whether you’re a solo provider, small to medium sized organization or a provider with multiple locations. Create your own scheduling templates for an unlimited number of locations and set up automated patient reminders. Billing is your one stop tool to manage patient registration, claims and payment. You can track all of your patient information and prior authorizations. It integrates easily with your EHR and helps keep track of your Meaningful Use certification. Billing lets you know if your claim has an error before it’s sent. Quickly re-submit your claim with no penalty, and monitor all of your EDI rejections.

Logix works in the background to complete tedious yet important workflow tasks like refill requests, prior authorizations, refill too soons, fax escalations, and phone call documentation. Other tasks, like fax and email, can be automated too. And you can alleviate human error on repetitive tasks as well. Plus, create notifications so you don’t forget what’s needed and can redirect time to focus even more on patients. Every keystroke and click counts! With Logix processes in place, you can reduce document handling & processing times by an average of 1-4 minutes per document. Logix is designed to work with DocuTrack to reduce keystrokes for your pharmacy workforce and make them more efficient. Reduce keystrokes needed to complete a process by up to 80 for some processes. How much can Logix save you? Use the calculator and see for yourself.

Leverage automation and intelligence to overcome patient access and revenue cycle challenges and increase reimbursements for patient care delivered. Despite the progress AI and automation is making in automating patient access and revenue cycle processes, there still remains a need for staff with RCM, clinical and compliance expertise to ensure patients seen were financially cleared and services rendered are accurately billed and reimbursed. We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape. Our technology and team learn from billions of transactions processed for leading healthcare providers and 1400 payers across the United States. Get quicker financial clearance for patients before care with our patient access plus a platform that provides complete coverage for obtaining eligibility verifications, benefit checks, patient pay estimates, and prior authorization approvals, all in one system.

Experience a seamless workflow by having real-time transactions driven within existing technology platforms. Providers and Payers reduce time and effort by up to 90% for benefits and utilization management. Eliminate the current benefits and utilization management black box – eliminating confusion for patients, providers and payers. Self-learning automation and fewer clicks mean more time for patients, providers and payers to focus on care. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates automated workflow and rules engines based on the actual responses and results from provider-payer interactions. Our technology continuously adapts to the rules in use by payers. The more you use it, the smarter it gets. A library of continuously-updated thousands of rules for national, state and regional payers.

Access numerous endpoints, securely and simply with one API connectivity and avoid developing one-offs to disparate healthcare systems. Bridge the gap between multiple systems, standards, and data sets, using a single point of access for developing interoperability. Consensus Harmony includes universal healthcare APIs, cloud fax APIs, electronic signature APIs, and connectivity to multiple participating EHR partners and other leading industry cloud marketplaces. Flexible interoperability options to programmatically integrate digital faxing, secure messaging, patient record requests, e-signatures, and more into key workflows like payments, prior authorizations, and referrals. Extend your capabilities and access new information networks by partnering and leveraging community providers already integrated. Don’t limit the network you communicate with, leave the modality of communication up to our technology.

Veradigm AccelRx delivers a free, automated, comprehensive solution to help you streamline specialty medication fulfillment for your patients. With faster time to therapy comes better odds for medication adherence and positive outcomes, as well as fewer phone calls and faxes for your staff. Combining electronic enrollment, consent, prior authorization, and script into an all-in-one system, AccelRx can help your practice significantly cut time-to-fulfillment for all specialty drugs, with any payer. Automatically populate patient data on enrollment and other forms with the click of a button. A single user-friendly platform to help you transform specialty medication management. Enhance your management of most specialty drugs all in one place, including electronic prior authorization (ePA). Access your enhanced specialty medication management as part of your existing electronic health record (EHR) workflow.

You’re dealing with staffing shortages and rising costs – of interest rates, salaries, and systems. And everywhere you look, you see struggling practices. But it doesn’t have to be this way. We have the solution. You can solve your staffing shortage by “hiring” OmegaAI. Omega AI is ready to be used immediately upon creation of an account. A cleaner, more focused interface eliminates the cumbersome and saves time. Enable easy interconnectivity between organizations and facilities. Enable patient autonomy with our integrated patient portal, Blume. Patients can navigate the entire medical imaging journey from their smartphone — they can upload referrals, insurance, history, and prior images, verify eligibility and prior authorization, schedule appointments, complete forms, make payments, view their images and reports, and share their images with doctors, family, and friends.

MediFusion is a fully integrated suite of software designed to offer innovative EHR and medical billing solutions to healthcare practices and enhance clinical, administrative and financial operations. Our team is just a phone call away to provide ongoing EHR training and be there for you whenever you need help and support. Speed-up your clinical processes and automate your workflow with our all-in-one integrated solution. A system that manages the entire revenue cycle from Eligibility Verification to Claim Processing and getting paid. Our cloud-based Electronic Health Record (EHR) software is an integrated and scalable solution to enable your practice to improve the quality of care provided to patients. This easy to use web-based EHR platform allows you to document, access and track your Clinical and Financial information on any internet-ready device no matter where you are.

The Cohere Unify platform supports all of our intelligent prior authorization solutions with touchless and predictive technologies, evidence-based clinical content, and other advanced capabilities. Our technologies reduce or eliminate manual steps toward creating an end-to-end fully automated prior authorization process. This predictive capability enables health plans to virtually eliminate prior authorization workflow steps. Instead, the system can automatically craft specific care plans based on patient and population auth and claims data, including multiple services that can all be pre-approved upfront before they are even requested. Evidence-based clinical criteria for select specialties that inform our touchless and predictive technologies. Proven single sign-on capabilities with Availity, NaviNet, and other common portal technologies. Rules configuration and deployment proven to scale over multi-million+ transactions.

Cohere helps health plans digitize the process and apply clinical intelligence to enable in-house, end-to-end automation of prior authorization. Health plans can directly license Cohere’s PaaS intelligent prior authorization for use by the plan’s internal utilization management staff. As a result, our client health plans achieve both significant administrative efficiencies and faster, better patient outcomes. Cohere delivers a tailored, modular, and configurable solution suite for health plans. Digitizes all prior authorization requests into a single automated workflow. Automates prior authorization decisions using health plan-preferred policies and accelerates manual review. Helps clinical reviewers adjudicate complex requests, using responsible AI/ML and automated capabilities. Leverages clinical intelligence with AI/ML and advanced analytics to improve utilization management performance. Improves patient and population outcomes with innovative, specialty-specific programs.

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large-sized healthcare settings, specialties, and payers from one platform and portal. Valer is the all-specialty, all-payer technology solution designed around your needs, not ours. Unlike off-the-shelf products that limit specialties, service lines, and payer mix (that don’t even automate submissions), Valer is explicitly customized to fit your needs. Because Valer is so easy to use, the dashboard increases staff productivity, simplifies staff training, and measures staff and payer performance across all service lines to enable continuous improvement. Valer doesn’t just connect to some of your payers for some of what you need. We link to all payers for all specialties, service lines, and care settings with real-time payer rule updates.

iMed e-Rx electronic prescription system starts from $43/month and can be used for writing both legend and EPCS compliant prescriptions. Which is Certified for e-Prescribing in all States. Our software has Electronic prior authorization and it has Formulary support. Our key highlights are Drug-Drug, Allergy, and Disease interaction checking, Database of drug stores with frequent updates, Drug therapy monitoring, 24/7 monitoring of script delivery and so on.

Powered by our advanced, cloud-based technology platform, XIFIN RPM is a comprehensive, highly automated Revenue Cycle Management solution that maximizes efficiency, refines medical cycle billing, improves cash collection, and increases financial accuracy. Diagnostic providers need financial management technology that not only helps improve cash collections, but also delivers visibility and control over financial operations, and provides connectivity within and beyond the organization. With these increasingly complex needs, diagnostic providers are poorly served by traditional billing systems that lack the referential and financial integrity required to deliver accurate, auditable information. Instead, they need a technology infrastructure with a solid financial and accounting foundation that delivers full visibility to understand the financial status of every diagnostic activity a provider performs, at every stage from order submission to payment.

Southern Scripts simplifies the complexities of navigating through the Pharmacy Benefit Manager world by giving the employer group complete freedom, control, and choice as to how they structure their plan. Southern Scripts is a leading pharmacy benefits manager (PBM) founded by pharmacists to reinvent the traditional PBM approach. Our innovative pass-through PBM model and flexible solutions empower plan sponsors to achieve maximum cost savings, decreased risk, and optimum versatility in plan design to achieve true patient-centered clinical care at the lowest net cost. Plan sponsor is charged the exact price the pharmacy is paid. We pass all discounts and rebates that we secure at 100% to the plan sponsor. No additional fees for standard PBM services, such as prior authorizations, step therapy, and data reporting. Our robust clinical management program and high-performance drug formularies deliver the lowest net cost to protect plans from unnecessary expenses.

Prior Authorization with AuthParency Prior authorization is a growing administrative burden for healthcare providers. Our automated prior authorization solution, AuthParency™, is powered by AI and machine learning (ML). This advanced system can cut your team’s prior authorization time in half. It is also compatible with all EHR and practice management systems AuthParency helps: Analyze payers’ tendencies Reduce patients’ days to care Improve patient outcomes Stop losses from non-reimbursable services Identify financial toxicity burdens Analyze population health data Track disparities Pharmaceutical companies

Save time with templates and patient charts in the cloud-based EHR that adapt to your needs. Browse from a library of medical charting templates built by practices like yours. Efficiently manage prescriptions including controlled substances and those requiring prior authorization. Seamlessly exchange information with local pharmacies, laboratories, imaging centers and other tools integrated into the EHR platform. Choose from over 500 lab and imaging centers to order tests and share results with patient. Flexible billing options with industry-leading partners who help you get paid faster. Monitor your progress with insightful dashboards and submit reporting data to CMS directly through your EHR. Access customizable dashboards to track your progress on quality initiatives like MIPS. Explore extensive education and training materials to navigate the complexities of quality measures.

The financial and administrative challenges facing healthcare providers are daunting. Waystar’s technology platform simplifies and unifies healthcare payments across the revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance, and ultimately collect more revenue. At Waystar, we know there’s a better, more efficient way forward. Let’s climb the mountain ahead of us to reach new heights in healthcare. We know that adopting new revenue cycle technology can seem like an obstacle. Whatever your existing systems, our cost-effective technology is compatible and gets up and running quickly. Our single sign-on platform lets you manage commercial, government and patient payments all in one place, so you can consolidate vendors and eliminate the hassle of multiple systems. Give your staff intuitive solutions that will make their jobs easier and their workflows more productive.