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Best Prior Authorization Products

Best Prior Authorization Products

Currently, we have identified 21 digital solutions in the prior authorization space, many of which integrate with leading systems like Epic, Cerner, Meditech, Allscripts, McKesson and others. This means you can choose a prior authorization solution that meets the unique needs of your healthcare organization and patients. 

What’s more, our verified client data for these solutions shows that dozens of health systems are already using prior authorization solutions. This demonstrates the growing acceptance of this technology among healthcare providers as a means of improving patient outcomes and reducing healthcare costs.

Prior authorization is a crucial management process in healthcare that ensures healthcare providers receive approval from payers before delivering specific services, preventing lost revenue and reducing expenses. AVIA Marketplace offers a range of digital health solutions and software designed to streamline the prior authorization process, enabling healthcare providers to focus on delivering quality care to their patients.

On this page, you'll find a curated list of prior authorization solutions, software, and tools that automate prior authorization requests, streamline workflows, and reduce administrative burdens. Our solutions help healthcare organizations to save time and resources, avoid denials and delays, and improve overall revenue cycle management.

At AVIA Marketplace, we're committed to providing the information and resources needed to make informed decisions about the right prior authorization software, solutions, and tools to implement in your healthcare system. Browse our listings and learn more about how our solutions can help streamline your revenue cycle and improve your bottom line. Search AVIA Marketplace for the top prior authorization solutions from leading vendors in the industry. 

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Prior Authorization: Products


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With the MCG Cite AutoAuth, payers and providers can rely upon an automated, evidence-based system to facilitate the prior authorization process. The web-based interface, provided through the payer’s portal, makes it easy for a provider to document and support treatment requests.

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VALER is a cloud-based **Enterprise Authorization Platform** that streamlines and automates today's manual authorization workflows. VALER provides **ONE place to SUBMIT and VERIFY authorizations across all payors and all services types** (professional, facility, ancillary, medications, etc). VALER is the only solution that manages authorization submissions for both payor **FAX** and **web portal** based workflows. VALER provides enterprise-wide visibility on **real-time authorization status** and documentation to eliminate duplicate work and support the revenue cycle.
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Direct is the leading EHR-integrated cost transparency solution. The solution brings real-time, medical and pharmacy benefit cost information, coverage restrictions, and alternatives into native EHR workflows. Giving providers cost information at the point-of-care enables data-driven and evidence-based decisions that help patients get the care they need at prices they can afford.

Features and Benefits:

 - Access to lower-cost alternatives increases care adherence and patient health and satisfaction

 - Select care/medications that do not require prior authorization

 - Reduced pharmacy/PBM/payer call-backs, prior authorization denials, and other uncompensated provider hassles

 - Uses native order workflows, is easy to implement

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Olive’s End-to-End Prior Authorization solution seamlessly connects to provider EHR systems, accelerates the prior authorization process, and empowers healthcare providers with an efficient prior authorization workflow management system, supplemented by automation and augmented by AI. Olive recommends a succinct clinical bundle to improve authorization approvals leading to increased revenue and patient throughput. Additionally, Olive includes comprehensive medical necessity criteria for tens of thousands of procedures to help you understand payer requirements and include better supporting clinical documentation, resulting in more first-pass prior auth approvals and reducing prior auth denials.

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There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble: - Automatically verifies, initiates, statuses and retrieves comprehensive authorization details - Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes - Integrates directly with all major HIS and PM systems - Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity - Adapts to constantly shifting payer rules and requirements - Was built and is maintained by our in-house team of experts
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These automated processes, which are part of the R1 Patient Experience, deliver accurate and complete authorizations directly within order and scheduling workflows to reduce administrative tasks, lower operational cost, streamline appropriate payment, and enhance the patient experience. With R1 Financial Clearance clients are able to get to “Schedule Ready” faster with sixty-seven percent of authorizations cleared within minutes and ninety-seven percent within 3 business days.
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Make your operations more efficient: With Passport Authorizations, inquiries take place without user intervention, as does status monitoring. Submissions guide staff through the workflow, auto-filling all information Experian Health has received and prompting users only if their involvement is required. Access the industry’s most complete payer database: Experian Health's pre-authorization knowledge base stores and dynamically updates payer prior authorization requirements. Your staff can check whether prior authorization is required for a particular procedure or service, and the knowledge base automatically responds to queries with information needed.
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Help Accelerate Prior Authorization: - Automate manual processes by determining if a pre-authorization is required and on file with the payer. - Create a consistent workflow for manual intervention of pre-authorization follow-up to ensure mission-critical steps are not overlooked. - Help reduce losses due to write-offs by automating Medical Necessity checking as part of registration, and perform clinical code auditing for Medicare outpatient services. - Monitor payers electronically for pending pre-authorization decisions with results automatically posted to your health information system. - Help reduce authorization-related claim denials by accessing an audit trail where the authorization verification was obtained and results were stored. - Create Advanced Beneficiary Notices with expected charges for the patient which allows them to accept liability prior to care delivery.
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Automated processing of paper-based prior authorizations. We are able to ingest any paper form, semantically understand the content, extract entities, and feed those to your downstream systems via API. Our end-to-end proprietary pipeline is tuned to the language and processes of healthcare, insurance and banking. The result? Consistent quality that is better than human.

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With InterQual Connect™, payers can easily automate all authorization requests, even those requiring medical review, within their existing systems. Providers receive quicker authorization approvals for most requests and payers only need to touch the exceptions that can’t be approved automatically—no more duplicative medical reviews or wasting precious staff time on routine authorizations. - InterQual Medical Review & Authorization: InterQual Connect is a flexible SaaS solution, integrated into payer and provider health information systems. It pairs the leading InterQual® Criteria, now available as a web service, with proven and secure connectivity. - A Unique Solution: The only integrated solution to enable full auto authorization, including medical review. - Uses Existing IT Infrastructure: No new hardware, software or IT staff required. - Easy to Implement: Time to value can be as little as 60 days when using a certified Change Healthcare Alliance Partner. - Provides Fast, Secure Connectivity: Uses the proven authorization gateway. - Keeps Users in Existing Workflows: Providers submit an authorization request, and payers receive the request and medical review from within their current UM/CM workflow. - Delivers Real-time InterQual Access: Just-in-time content from our cloud platform helps ensure you get the latest version, but you can choose when to make the switch. - Aligns with InterQual Hospitals: Payers benefit from the shared clinical language with thousands of InterQual hospitals plus a direct connection to those hospitals already on the InterQual Connect cloud. - Supports Payer/Provider Collaboration: Helps reduce the costs and hassle of prior authorization, while providing full transparency of payer criteria to providers. - Medical Review Service: Optimized for integration, this web service delivers seamless access to the InterQual medical review within your UM/CM system or payer’s provider portal. You get the same leading evidence-based InterQual Criteria combined with our modern, user-friendly interface. The SaaS platform helps you reduce your IT burden, providing realtime access to content. You receive software and content upgrades automatically without waiting for installation and validation, but still maintain control of when to switch to the newer content. You also gain the freedom to make the Medical Review Service available throughout a networked system, such as a multi-hospital and outpatient network or multi-location payer. The Medical Review Service works with any modern browser. - Secure Authorization Connectivity: Our cloud platform and authorization gateway enable the creation of a secure network of connected payers and providers by providing a common language, standard API protocols, access controls and routing rules. Providers transmit an authorization request, complete with an InterQual medical review, through the gateway directly to a payer. The payer system then applies business rules and the InterQual Criteria to this request, and instantly delivers the authorization status back through the gateway to the provider. The gateway has been deployed as part of our cloud solutions, and currently supports thousands of authorization transactions per week between connected payers and providers. It is optimized for our interoperable (XML) medical review format, and can also support the HIPAA X12 278 transaction standards.
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AVIA Marketplace offers a product grid that is a comprehensive resource for health care buyers in their research journey. The grid showcases products from leading vendors and ranks them based on match scores and market presence. This approach ensures that the products listed are not only relevant to the buyer's needs but also established in the market. The product grid includes detailed information about each product, such as features, benefits, and pricing, making it easy for buyers to compare and evaluate their options. With AVIA Marketplace's product grid, health care buyers can make informed decisions and select products that meet their specific requirements.

Buyer's Guide


Prior authorization is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.

What is prior authorization?

Prior authorization–sometimes called precertification or prior approval–is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses. When patients seek prior authorization–typically for more complex or costly treatments or prescriptions–payers may approve or deny requests, ask for more information, or require that the patient receive an alternative treatment before approving the initial request.

The case for digital prior authorization

The current prior authorization process is extremely burdensome and time-consuming–the average physician must complete 41 prior authorizations per week, which translates into about 14 labor hours just for completing prior authorizations, according to a 2020 American Medical Association survey. It's also one of the most costly administrative transactions, with an average expenditure of about $11 for each request. But the prior authorization landscape is changing, and the lost time and sunk costs are decreasing as intelligent automation becomes commonplace.

While a manual prior authorization takes an average of 21 minutes, a digital transaction can be completed in about four minutes, with fewer denials and faster turnaround time.

How digital prior authorization process works

While the steps remain unchanged between digital and manual processes, an end-to-end automated solution alleviates the administrative burden and virtually eliminates errors that can lead to delays and denials.

  1. Determine prior authorization requirements. The leading solutions continually scrape payer sites to maintain real-time information on tens of thousands of payer policies.
  2. Complete the prior authorization form. Intelligent prior authorization software identifies and fills out the appropriate prior authorization form based on the patient’s specific payer requirements.
  3. Collect the appropriate documentation. The leading solutions automatically collect and append clinical documentation from the EHR. Staff can review and validate information prior to submission.
  4. Submit the request for prior authorization and monitor for status updates. After staff review and approve the request, it’s automatically submitted through the appropriate web portal. An intelligent dashboard displays real-time status updates.

What leading digital prior authorization solutions offer

Requirements identification
Top solutions automate whether a prior authorization is required and can identify payer-specific rules without additional manual research from staff.

Requirements knowledge base
The prior authorization requirements knowledge base should be continually and automatically maintained, with minimal (if any) support from the health system.

Automated form completion
Leading prior authorization solutions integrate with the EHR and leverage structured and unstructured data to populate the appropriate fields and save time for physicians and staff.

Forms library
End-to-end solutions should include a forms library, where necessary payer-specific forms can be created and maintained.

Documentation collection
Intelligent documentation collection automatically pulls necessary documentation from the EHR and helps reduce denials based on incomplete or missing information.

Automated request submission
Capabilities should include automated submission on behalf of the provider through efax, payer portals, third-party sites and other access points.

Status monitoring
The leading solutions offer continuous status monitoring and push update and other relevant information back to the appropriate work queues and fields in the EHR.

Organizing for digital prior authorization success in your health system

Before implementing end-to-end automation in the prior authorization process, hospitals and health systems must:

  • Have a mature EHR with no planned changes in the near future.
  • Ensure that prior authorization practices are documented and standardized.
  • Obtain organizational buy-in from revenue cycle leadership and operations.

Other capabilities that health systems should deploy to successfully implement digital prior authorization include:

  • Mechanisms to track prior authorization performance at the department and leadership levels.
  • Integration with business systems like EHRs, call center tools and customer relationship management–this eliminates duplication of information and ensures accurate data capture.
  • Strong internal communication to educate staff about prior authorization capabilities and appropriately calibrate responsibilities.
  • Open lines of communication across payer relationship and revenue cycle teams to efficiently respond to procedural changes and resolve problems.