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SMILE PRIOR AUTHORIZATION


Meet and go beyond CMS mandates with Smile's seamless and integrated solution.

CHALLENGES WITH PRIOR AUTHORIZATION

In the healthcare industry, manual Prior Authorization (PA) processes have become a significant burden. They lead to delays, frustration, and unnecessary costs for both providers and payers. According to the American Medical Association*, 93% of physicians report care delays due to Prior Authorization. It is estimated that payers spend about $26B annually on heavily manual administrative processes like PA.  

AUTOMATE PRIOR AUTHORIZATION

With Smile’s electronic Prior Authorization, a component of the Smile CMS Suite, payers can meet regulation requirements while reducing your PA burden and operational costs.   We generate an automated workflow that delivers approvals in real time at the point of care delivering a delightful experience for both your providers and members.  

SMILE e-PA COMPONENTS

Coverage Requirements Discovery (CRD) Module

Electronically inquire if PA is required.

Documentation Templates and Rules (DTR) Module

Obtain payer rules and automate requested documentation.

Prior Authorization Support (PAS) Module

Submit PA request and receive real-time response.

Clinical Quality Intelligence Engine

Converts your business rules and policies to computable knowledge enabling automation.

WHY CHOOSE SMILE?

Complete Compliance

As FHIR experts, our solutions align with healthcare standards and mandates, making compliance seamless.  Smile offers solutions for all CMS mandates: Patient Access, Provider Access, Payer-to-Payer, and PARDD.
Streamlined Automation

Exceed mandate requirements with real-time determination and 24/7 automated prior authorization response to generate real savings and delight your providers.
Scale and Performance

Be prepared for growth with Smile’s proven scale of ingesting and standardizing over 2 Billion resources in 26 hours at a performance of 255,000 transactions per second.
Modular and Comprehensive Smile isn’t just a silo solution, built on our FHIR native Health Data Platform, our solutions are foundational to modernizing your entire data strategy and can be the building blocks for your future.

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FEATURED WEBINAR: BEYOND REGULATIONS

Empowering Healthcare with Smile's Advanced Solution
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