Virtual Learning Center
The Urgent Need for Payers to Address Prior Authorization and FHIR
With the impending integration of prior authorization procedures and FHIR standards within the next couple of years, it’s critical to understand the current landscape. From how to effectively implement change to understanding whether your current systems can effectively integrate with the end solution you want, there are questions you should be asking now before implementing your long-term prior auth strategy.
Recently, Itiliti Health CEO Michael Lunzer joined Huthaifa Khan, Director of Solutions Architecture at VirtualHealth to discuss implementation and timelines for the latest FHIR requirements. Itiliti Health continues to pioneer the future of FHIR and prior authorization, which is underscored in this insightful video on the new regulations. Listen in to learn why healthcare payers must urgently address these requirements well in advance of the upcoming deadline.
Have questions, or want to schedule a demo? Reach out to Steve McLeod, SVP of Sales, at smcleod@itilitihealth.com
CMS rule on Interoperability and Electronic Prior Auth: Gaining Compliance and Improving Prior Auth Processes
- The Direct Impact of CMS Rule 0057-F: Understanding how this critical regulation affects both healthcare payers and providers.
- Rule Provisions Explained: Clear, concise explanations of what this rule entails and what it means for the healthcare landscape.
- Strategic Planning for Payers: Guidance on how payers can effectively devise strategies to comply with these new requirements.
- Rethinking Utilization Management (UM): How to adapt your UM processes incorporating automation for efficiency and cost reduction.
- The Significance of Provider Engagement: Why fostering strong relationships with providers is a key to achieving a return on investment.
- Deep Dive Into X12 vs. FHIR Standards: Expert analysis on the technical standards shaping the future of digital health transactions.
- Achieving End-to-End Digital Prior Authorization: A step-by-step look at implementing a solution that meets digital prior authorization needs comprehensively.
- Compliance Strategies with CMS Prior Auth API Requirements: Practical advice on ensuring your systems are compliant with the new API requirements.
Have questions, or want to schedule a demo? Reach out to Steve McLeod, SVP of Sales, at smcleod@itilitihealth.com
Complexities and solutions surrounding the recently finalized CMS interoperability rule 0057
Join Michael Lunzer, CEO of Itiliti Health, as he dives into the complexities and solutions surrounding the recently finalized CMS interoperability rule 0057.
In this insightful discussion, Michael explains the rule’s requirement that payers implement a prior authorization API by the end of 2026, how Itiliti Health helps insurance companies gain compliance with this new rule, and how to streamline prior authorization processes, resulting in improved member and provider experiences, reduced costs, and faster turnaround times.
Have questions, or want to schedule a demo? Reach out to Steve McLeod, SVP of Sales, at smcleod@itilitihealth.com
Navigating the intersection of regulatory oversight and healthtech
Innovative technologies like AI and automation serve as integral components in addressing the challenges that come with health equity, provider burnout and prior authorization. But how can organizations understand the true complexities of these issues and use these technologies in the right way to create solutions that work with the human oversight that’s needed for success?
Michael Lunzer, CEO of Itiliti Health; Vimbai Mudimu, associate principal at ZS; and Vikas Garg, principal at ZS, discuss several key issues that meet at the intersection of regulatory oversight and health tech.
Watch this on-demand webinar for a conversation that includes:
- A regulatory update on recent Centers for Medicare & Medicaid Services (CMS) updates relating to health equity in utilization management
- The challenges of provider burnout, what’s impacting rising rates of burnout and how this affects both health plans and providers
- How AI and automation can be leveraged to create better outcomes and administrative cost savings payers can hope to realize
- What touchless prior authorization means and how this solution can contribute to better clinical decisioning
Note: This webinar was recorded on Jan. 12, 2024, just before the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule to streamline processes and reduce wait time. The passing of this rule makes this webinar and the insights shared timelier and more imperative.
Please reach out to us with any questions: sales@itilitihealth.com
The Cost of Prior Authorization - and How to Change the Narrative within Your Organization
It’s a new year, yet many organizations are still wrestling with the same old challenges with prior authorization. As we step into 2024, there is a pressing need to transform this narrative.
Itiliti Health CEO Michael Lunzer recently shared his insights on the mounting challenges both payers and providers are encountering in the realm of prior authorizations. In this video, he:
- Outlines the true burden of prior authorization
- Identifies where high costs associated with prior auth originate
- Shares innovative strategies to help organizations alleviate the pain associated with prior authorizations
- And more
Please reach out to us with any questions: sales@itilitihealth.com
AI + Automation in Prior Auth: A Candid Conversation with Dr. Jerry Osband and Michael Lunzer
In this conversation, we’ll discuss:
- An update on the prior auth regulatory environment
- How AI, automation, and machine learning fit into the regulatory landscape
- How AI is working to improve PA process challenges
- What needs to be demonstrated to provide and assure security and compliance in the approach to AI
- How rules and regulations will likely evolve in the future
- Who health plans should involve in key decisions surrounding prior authorization technology
- What payers should be doing before implementing prior authorization automation
- When organizations should be looking to gain compliance with upcoming regulations
- And more!
Please reach out to us with any questions: sales@itilitihealth.com
Webinar: Exploring Advanced Utilization Management
Discussing Challenges and Solutions for Advanced UM and Prior Authorization
With increased attention around improved utilization management (UM) and advanced prior authorization following recent CMS rulings and regulation changes, it’s prime time to have a deeper discussion about the advances in UM and the importance of automation and intelligence for both.
Join experts from the product and solutions teams at VirtualHealth, Edifecs and Itiliti Health, two leading technology companies within the utilization management and prior authorization space, to explore core utilization management and prior authorization challenges, the importance of optimizing both, and solutions for a modernized UM and prior authorization approach.
Please reach out to us with any questions: sales@itilitihealth.com
How to streamline prior authorization and reduce the burden of PA by 30%
- Achieving millions in administrative savings
- Immediately reducing human capital needs
- Organizing and improving their prior auth processes
- Meeting regulatory requirements
- Eliminating prior auth disputes
FHIR Prior Authorization ("PARDD") API: Requirements and Implementation for Payers
In this video, Itiliti Health CEO Michael Lunzer addresses the upcoming prior authorization regulations proposed by CMS, what you can do now to become compliant, and how you can achieve a return on investment, even before providers adopt the full automation interfaces.
If you would like to learn more, we are here to help. We are happy to provide you with a free consultation to discuss how the FHIR prior auth requirements will impact your organization and what it could look like to gain compliance without major modifications to your existing system. We also provide ongoing email updates to keep you informed on regulatory changes in prior auth.
Note: This webinar was recorded before the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule to streamline processes and reduce wait time. The passing of this rule makes this webinar and the insights shared timelier and more imperative.
The Benefits of Prior Authorization Transparency
We’re thrilled to share the replay of our webinar with Blue Cross and Blue Shield of Minnesota along with Mayo Clinic. In this virtual event, Itiliti Health CEO Michael Lunzer hosted a candid conversation with Bobbi Maddox from BCBS Minnesota and Grant Kocer from Mayo Clinic. We discuss various ways our PA Checkpoint tool helps payers:
- Simplify their pre-authorization processes
- Optimally deploy their workforce
- Save millions of dollars each year in administrative costs
Please reach out to us with any questions: sales@itilitihealth.com