CleanVues Prior Authorization
Meet and exceed CMS mandates with CleanVues seamless, integrated solution.
CHALLENGES WITH PRIOR AUTHORIZATION
In the healthcare industry, manual Prior Authorization (PA) processes have become a major challenge, causing delays, frustration, and unnecessary costs for both providers and payers. According to the American Medical Association, 93% of physicians report care delays due to PA requirements. Payers are estimated to spend approximately $26 billion annually on manual administrative processes like PA.
AUTOMATE PRIOR AUTHORIZATION
With CleanVues electronic Prior Authorization, part of the Cleanvue CMS Suite, payers can meet regulatory requirements while significantly reducing the PA burden and operational costs. Our automated workflow delivers real-time approvals at the point of care, ensuring a seamless and positive experience for both providers and members.
CleanVue e-PA COMPONENTS
Coverage Requirement Discovery(CRD) Moduule
Electronically inquire if PA is required.
Documentation Templates & Rules(DTR) Module
Obtain payer rules and automate requested documentation.
Prior Authorization Support (PAS) Module
Submit PA request and receive real-time response.
Clinical Quality Intelligence Engine
Converts your business rules and policies to computable knowledge enabling automation.
WHY CHOOSE CLEANVUE
As FHIR experts, our solutions are fully aligned with healthcare standards and mandates, ensuring seamless compliance. Smile provides solutions for all CMS mandates, including Patient Access, Provider Access, Payer-to-Payer, and PARDD.
Exceed mandate requirements with real-time determinations and 24/7 automated prior authorization responses, driving real cost savings while enhancing provider satisfaction.
Prepare for growth with Smile’s proven scalability, capable of ingesting and standardizing over 2 billion resources in 26 hours, processing up to 255,000 transactions per second.
Cleanvue isn’t just a silo solution, built on our FHIR native Health Data Platform, our solutions are foundational to modernizing your entire data strategy and can be the building blocks for your future.
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