Overview
skyAuth for Payors streamlines the prior authorization review and decision process for health plans. It automates medical necessity reviews, reduces turnaround times, and improves consistency in authorization decisions.Key Capabilities
Automated Review
AI-powered medical necessity determination
Clinical Criteria
Apply evidence-based clinical guidelines consistently
Decision Support
Support reviewers with relevant clinical information
Features
Automated Determination
Apply clinical criteria automatically to straightforward cases, reducing reviewer workload.Clinical Guidelines Integration
Integrate with evidence-based guidelines like InterQual, MCG, and custom criteria.Reviewer Workbench
Provide reviewers with all relevant information in a streamlined interface.Performance Analytics
Track authorization metrics, turnaround times, and decision patterns.Use Cases
- Medical Necessity Review: Automate routine medical necessity determinations
- Utilization Management: Manage inpatient and outpatient utilization reviews
- Pharmacy Authorization: Process prescription prior authorization requests
- Appeals Processing: Streamline the appeals review process