Use Case
Prior Authorization
Streamlines and automates prior authorization decisions and provides real-time determinations
You are already doing this today, why not make it easier?
Prior authorization is a critical yet cumbersome process in healthcare, often causing delays in patient care due to administrative burdens and inefficiencies.
The hard way
Providers want to ensure claims will be paid by confirming coverage and validating prior authorization requirements.
While fax and phone are still used, providers often login to 20+ different payer web portals. As a result, they are left to manage:
- 20+ usernames and password
- Disjointed user experiences
- Lots of manual searching and data uploads
Creating inefficient processes that create administration burden.
The new way
By leveraging our SMART-on-FHIR Proxy application and Networked FHIR, along with HL7 Da Vinci specifications, eHealth Exchange is streamlining and automating prior authorizations and eliminating costly point-to-point connections.
The DURSA, our trust agreement, simplifies the process by allowing payers to connect with multiple providers and providers to connect with multiple payers.
Reducing provider and payer burden
Drastic Reduction in Processing Time
Operational Efficiency Gains
Improved Patient Care
Networked FHIR Offers Scalability
Let us show you how it works
The eHealth Exchange SMART-on-FHIR Proxy App streamlines and automates coverage eligibility and prior authorizations with real-time determinations.
Connecting payers and providers
eHealth Exchange provides a single nationwide legal agreement with one technical connection for payers to connect to multiple providers and providers to connect to multiple payers, enabling a simplified prior authorization process and a proven SMART-on-FHIR approach to payer APIs.
Eliminate costly point-to-point integrations between payers and providers
Streamline and automate prior authorization decisions and provide real-time determinations.
Expediate medical reviews with on-demand access to clinical documentation to support the claims process.
Reduce administrative burden by minimizing the back-and-forth information requests.
Support care coordination and value-based care determinations.
Increase compliance with federal regulations for payer interoperability and information blocking
Technical Specifications
FHIR Version R4
Da Vinci Prior Authorization Implementation Guide
SMART App Launch
US Core Implementation Guide
Da Vinci Health Record Exchange (HRex)
Now is the time to abandon manual and disjointed workflows.
Expand your access and connectivity to the U.S. healthcare system with eHealth Exchange
