Integrated solution to expedite prior authorizations
SEATTLE: MCG Health, part of the Hearst Health network and a leading provider of informed care strategies, has expanded the partnership with ZeOmega®—delivering Jiva 6.1, the industry’s leading end-to-end population health management platform. Together, the organizations offer a streamlined solution—MCG Cite AutoAuth integrated with Jiva from ZeOmega. This solution enhances payer-provider collaboration by automating the authorization process while maintaining decision quality to support the timely delivery of effective care.
To ensure appropriate care and control costs, payers often require prior approval for certain procedures and services. Unfortunately, this process can be costly and time-consuming. According to a CAQH Index report, in 2015, 35% of prior authorization requests were submitted manually (via phone, fax, or email) and cost payers $3.68 per transaction as opposed to just $0.04 per electronic transaction1. The low adoption of electronic prior authorizations and the high cost of manual processing create organizational inefficiencies and highlight the need for an easy-to-use solution that automates this process.
MCG’s evidence-based care guidelines and the MCG Cite AutoAuth solution seamlessly integrate within the Jiva Provider Portal from ZeOmega, allowing providers to submit and document prior authorization requests within a single platform. Granting providers access to MCG’s content reduces unwarranted clinical variation by ensuring interventions are evidence-based so patients receive appropriate care.
In addition, payers can set custom rules that allow providers to receive instant determinations (along with supporting documentation) for designated procedures and services. This limits the number of authorizations that require medical review and reduces time spent waiting on determinations, increasing both provider and patient satisfaction. The Jiva Provider Dashboards ensure ease of use and transparency when tracking requests—submitted, pending, and approved—with automated notifications delivered directly to the provider.
“The ability to document care decisions within a single platform will help both payers and providers improve productivity,” says Sada Babu Rai, co-founder, president, and chief operating officer of ZeOmega. “It assists with the advancement of overall outcomes for the member, the care team, and the organization as a whole. Working with MCG Health to enhance payer-provider collaboration and progress population health management is a true honor.”
“We are proud to partner with ZeOmega to provide a solution that automates the authorization process while maintaining a standard in care delivery,” said Jon Shreve, president and CEO of MCG Health. “This integration not only leads to time and cost savings for healthcare organizations, it improves the patient experience by ensuring they receive the care they need when they need it.”
