The latest phase in the Centers for Medicare & Medicaid (CMS) push for interoperability takes aim at prior authorization. This specifically looks to reduce both patient and provider burden through improved data exchange.

At Telligen, we’ve already developed solutions to meet the needs of:

    • Medicaid compliance with the CMS Interoperability and Prior Authorization Rule.
    • Integrating with providers’ EHR for seamless, automated PA and UM service requests.
    • Leveraging FHIR-based API data standards for easy implementation and lower costs.
    • Reducing provider burden – elimination of portals, faxes and phone calls.
    • Reducing payer burden – returns EHR data specific to a service request, reducing nurse time and requests for additional information.
    • Improving member experience – timely, accurate decisions for receiving care.