PAHub
As Prior Authorization volumes continue to rise, and as specialty drugs create additional clinical complexities, Health Plans, Pharmacy Benefit Managers (PBMs) and Third-Party Administrators (TPAs) are challenged to adapt while maintaining or improving operational and clinical efficiencies. PAHub, is a HITRUST certified solution that puts the tools at your fingertips to streamline and control all clinical, compliance and administrative aspects of Prior Authorization at the point-of-care to improve compliance, reduce turn-around times and costs. By leveraging the latest technologies for data mining, data analytics, content management and advanced decision support trees, PAHub, enables customers to automate the end-to-end prior authorization process.
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EpiSoft
EpiSoft is a cloud-based medical software provider offering solutions for various healthcare specialties, including oncology, mental health, hospital preadmissions, hepatitis, and inflammatory bowel disease. Their platform includes electronic medical records (EMR), practice management, infusion drug management, and patient engagement portals. EpiSoft's EMR features integration with Medicare, health funds, and the Department of Veterans' Affairs (DVA) for faster claim payments, a scheduling module for complex care plans like chemotherapy cycles, and electronic prescriptions with seamless medication management. The cloud-based service allows access from any device, and automated SMS and email appointment reminders help reduce no-shows and cancellations. The patient portal integrates with existing hospital websites and patient administration systems, capturing validated health history and demographic data directly from patients, thereby easing administrative burdens.
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Valer
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.
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Cohere PaaS Intelligent Prior Authorization
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.
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