Best Prior Authorization Software for Government

ScriptSure Cloud ERX is the #1 E-Prescribing application available. ScriptSure combines weekly updates to medications, daily updates to pharmacy lists, full e-prescribing network connectivity, Electronic Prescribing of Controlled Substances (EPCS), web-based access and simple workflow methods to deliver the best in E-Prescribing. Electronic refills, order sets, compound medication order, printing prescriptions, patient reports and audit logs are all included and supported in ScriptSure Cloud ERX. ScriptSure is fully HIPAA compliant. ScriptSure Cloud ERX is the winner of the 2021, 2022 & 2023 Surescripts network White Coat Award for Most Accurate Prescriptions and a total 11-time award winner of this prestigious award.

Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status online, and receive remittance advice. Accepting standard ANSI formats, data entry, and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.

EHR 24/7 by Office Ally empowers more than 20,000 users with efficient patient care management. It has charting, real-time data, customizable forms, and integrations for patient intake and e-prescription solutions. With no implementation needed, healthcare providers can use EHR 24/7 to treat and document patients today.

RXNT's cloud-based integrated Electronic Health Records (EHR), software with E-Prescribing and Patient Portal optimizes patient treatment and streamlines workflows in practices of all sizes and specialties. Providers have access to the most current patient health information and prescription history from one database, accessible from any device. Integrated communications allows providers to share real-time clinical information with patients and clinicians, allowing for better care coordination. The use of "smart keys" and intake forms allows for customization and eliminates redundancy. Your practice will enjoy the Patient Check-In feature and integrated Electronic Prescribing. HIPAA compliant, ONC certified, EPCS-certified and meets MACRA/MIPS requirements. RXNT also offers Practice Management (PM), which includes Medical Billing, Scheduling, and standalone E-Prescribing. You can choose a solution by the piece with predictable pricing or you can implement our Full Suite for one, integrated platform.

Optimize your workflow by utilizing customizable templates and patient charts within a cloud-based EHR system designed to meet your specific requirements. Access a wide array of medical charting templates created by similar practices for enhanced efficiency. Effectively manage prescriptions, including those that are controlled or require prior authorization, while ensuring smooth communication with local pharmacies, labs, imaging centers, and other integrated tools within the EHR ecosystem. Select from more than 500 lab and imaging facilities to order tests and easily share results with patients. Benefit from versatile billing solutions provided by top industry partners to accelerate your payment process. Track your performance through insightful dashboards and effortlessly submit reporting data to CMS directly via your EHR system. Utilize customizable dashboards to monitor your progress on quality initiatives such as MIPS, while also taking advantage of comprehensive educational resources to help you understand the intricacies of quality measures. In addition, the platform offers ongoing support and updates to ensure you remain compliant with the latest healthcare standards.

Waystar offers market-leading technology that streamlines and unifies revenue cycle. Their cloud-based platform streamlines workflows, improves financials for all healthcare providers and provides more transparency to the patient's financial experience. Waystar has been ranked best in KLAS for Claims & Clearinghouse every year since 2010. It has also received #1 rankings in Black Book™, surveys since 2012, and the Frost & Sullivan North America Customer Valu Leadership Award for ambulatory RCM service in 2019. Waystar is used by over 450,000 providers, 750 hospitals and 5,000 plans. It integrates with all major HIS/PM systems. Waystar.com and @waystar on Twitter provide more information.

Practice Mate by Office Ally is a comprehensive HIPAA-compliant practice management solution used by over 25,000 healthcare organizations. Its user-friendly interface simplifies revenue cycle and billing management and streamlines booking to increase administrative workflow efficiency. It seamlessly integrates with other Office Ally solutions to provide patient intake, reminders, and e-prescriptions. You can get started today at no cost, commitment, or implementation to reduce administrative tasks, enhance job satisfaction, and improve the overall patient experience.

Azalea is a leader in interoperable cloud-based healthcare services and solutions. Azalea's platform offers electronic health records with integrated telehealth functionality, revenue cycle management, and analytic software. Azalea's integrated platform is focused on customer success and can be used by all practices and hospitals ambulatory strategies. It instantly improves cash flow and clinical outcomes through care coordination innovation and revenue cycle performance.

Medical necessity denials represent a significant financial burden for healthcare providers, incurring costs that can reach into the millions annually due to write-offs, along with the expensive labor involved in investigating and contesting these denials while addressing patient inquiries. Conversely, payers also face similar challenges in the claims management process, as they incur expenses from covering unnecessary medical procedures and treatments, as well as the resources dedicated to handling denial appeals, all of which do not contribute to better patient outcomes. Additionally, patients may suffer from excessive copays and other out-of-pocket expenses, coupled with a frustrating healthcare experience due to charges and services that are not warranted. To combat these issues, the ABN Assistant™ from Vālenz® Assurance equips providers with essential prior authorization tools to confirm medical necessity, generate Medicare-compliant Advanced Beneficiary Notices (ABNs) that include estimated costs, and effectively prevent over 90 percent of medical necessity denials by ensuring that the necessity is validated before any care is administered to the patient. By utilizing this system, providers can enhance their financial stability while improving patient satisfaction and care efficiency.

MedicsRIS is an all-encompassing radiology information system designed to enable radiologists to efficiently oversee their practice and ensure proper payment for each diagnostic examination. Created by Advanced Data Systems, this innovative platform allows for the seamless integration of orders from referring physicians' stage 2 certified electronic medical records (EMR) without the need for expensive HL7 interfaces, thereby helping users take advantage of incentives while steering clear of penalties. Among the core features that enhance operational efficiency are a dedicated portal for referring physicians, automated billing with EDI, multi-modality scheduling, insurance eligibility checks, mammography tracking, and additional functionalities. Furthermore, MedicsRIS provides access to a qualified Clinical Decision Support (CDS) option through its portal for referring physicians and radiology departments that lack their own qualified Clinical Decision Support Mechanism (qCDSM). If the manual process of obtaining prior authorizations has been a challenge, our automated prior authorization feature offers a solution by facilitating this task online directly within the MedicsRIS system, thereby streamlining workflows and saving valuable time. Ultimately, the integration of these features aims to enhance the overall efficiency of radiology practices.

We are dedicated to driving forward innovative approaches that cater to the needs of all healthcare stakeholders, aiming to enhance the speed of therapy delivery, minimize prescription abandonment rates, and foster better health outcomes for patients. Our commitment lies in dismantling barriers to healthcare access, whether that involves addressing prior authorization issues or increasing awareness of available support services. With healthcare costs reaching new heights, it is vital to assist patients in affording their prescribed treatments, especially in the context of high-deductible health plans, rising copays, and a lack of transparency. For many patients, maintaining adherence to their therapy can be the most challenging aspect of their healthcare experience, whether it involves understanding how to properly take medications or just remembering to do so at the appropriate times. Thus, it is crucial to tackle these adherence challenges with solutions that prioritize the needs of individuals first, ensuring they receive the support necessary to navigate their treatment journey successfully. By focusing on patient-centric strategies, we can create a more accessible and supportive healthcare environment for everyone involved.

MDToolbox-Rx is a renowned electronic prescription writing solution that is both certified and award-winning, capable of operating independently or in conjunction with your existing office software. This e-prescribing platform is designed to be highly customizable and user-friendly, enabling users to effortlessly choose medications, access drug information, and swiftly create and transmit prescriptions electronically. Certified for e-Prescribing, Eligibility verification, Formulary checks, EPCS (e-Prescribing of Controlled Substances), and Electronic Prior Authorization, MDToolbox-Rx ensures a comprehensive approach to medication management. Users can search an extensive drug database by various criteria, including name, nickname, generic or brand classification, prescription status, over-the-counter status, drug class, or medical indication. By streamlining workflows, this software significantly boosts productivity by reducing the number of pharmacy calls and minimizing the time required for prescription renewals. Overall, MDToolbox-Rx enhances the efficiency of the prescribing process, making it an essential tool for healthcare providers.

PracticeAdmin Scheduling enhances patient engagement and minimizes no-show rates by delivering essential data right when you need it. Our innovative rules-based framework allows customization of preferences for various providers, whether you operate solo, manage a small to medium-sized organization, or oversee multiple locations. You have the flexibility to design unique scheduling templates for countless locations and automate patient reminder notifications. The billing component serves as a comprehensive solution for managing patient registrations, claims, and payments seamlessly. You can keep a meticulous record of all patient data and prior authorizations, ensuring that everything is organized. Additionally, it integrates smoothly with your EHR system, aiding in the maintenance of your Meaningful Use certification. Billing also alerts you to any claim errors before submission, allowing for expedient re-submission without penalties while you keep track of all EDI rejections effectively. This streamlined approach ultimately empowers healthcare providers to optimize their administrative tasks and enhance the overall patient experience.

Experience a streamlined workflow with real-time transactions integrated into current technology platforms. This approach enables providers and payers to cut down on time and effort by as much as 90% when it comes to benefits and utilization management. By eliminating the opaque nature of the existing benefits and utilization management system, confusion is significantly reduced for patients, providers, and payers alike. With self-learning automation and fewer clicks required, more time can be dedicated to patient care, allowing providers and payers to concentrate on what truly matters. Myndshft addresses the complexities of multiple point solutions by offering a cohesive, end-to-end platform that facilitates immediate interactions among payers, providers, and patients. The platform not only dynamically updates its automated workflows and rules engines based on real-time feedback from provider-payer interactions but also continually adapts to the specific rules utilized by payers. As usage increases, the system becomes increasingly intelligent, drawing from a comprehensive library of thousands of regularly updated rules tailored for national, state, and regional payers, thereby enhancing efficiency and effectiveness in the healthcare landscape. Ultimately, as the technology evolves, it fosters an environment where care delivery can be optimized, benefiting all stakeholders involved.

Logix runs in the background and completes tedious but important workflow tasks such as refill requests, prior authorizations refill too soons, refill too quicklys, fax escalates, and documentation for phone calls. Other tasks like email and fax can also be automated. You can also reduce human error in repetitive tasks. You can also create notifications to ensure you don't forget anything and allow you to redirect your time to better serve patients. Every click and keystroke counts! Logix processes can be used to reduce document handling and processing times by an average 1-4 minutes per document. Logix can be used with DocuTrack to help reduce keystrokes and improve efficiency for your pharmacy staff. For some processes, you can reduce the number of keystrokes required to complete a process by as much as 80. Logix can help you save up to 80 keystrokes per process. You can use the calculator to see for yourself.

Rhyme facilitates a smart integration between payers and providers within the prior authorization process, effectively reclaiming valuable time lost in repetitive communications and redirecting it to benefit the patient. While automating routine tasks is essential (and that's our focus), it doesn't stop there. In situations where the intricacies of clinical decision-making necessitate collaboration between payers and providers, Rhyme ensures your workflow remains streamlined, flexible, and efficient. We have developed the most extensive integrated prior authorization network, moving away from a fragmented system and fostering intelligent cooperation. Our platform boasts robust relationships and connections to EHRs, payers, and benefits managers, all seamlessly integrated. This means no frantic searches, no cumbersome screen-scraping, and no reliance on indirect information. We engage with providers and payers directly within their current systems and workflows, making connections straightforward so that we can adapt to your needs rather than forcing you to change. Prior authorizations are not just an ancillary feature of our platform; they are our core focus, ensuring that we excel in this area and provide exceptional service. By prioritizing these elements, we aim to transform the way prior authorizations are managed and enhance the overall experience for all parties involved.

Utilize automation and advanced intelligence to tackle challenges related to patient access and the revenue cycle while enhancing reimbursements for the care provided. Even with the advancements in AI and automation streamlining patient access and revenue cycle operations, there remains a critical requirement for personnel skilled in revenue cycle management, clinical practices, and compliance to ensure that patients are financially vetted and that services rendered are billed and reimbursed correctly. We offer our clients a comprehensive combination of technology and team support, backed by extensive knowledge of the intricate reimbursement landscape. Drawing insights from billions of transactions processed for prominent healthcare providers and over 1,400 payers nationwide, our technology and team are uniquely equipped to deliver optimal results. Experience faster financial clearance for patients prior to receiving care with our patient access platform, which offers a holistic approach to eligibility verifications, benefit checks, patient payment estimates, and prior authorization approvals, all integrated into a single system. By streamlining these processes, we aim to enhance the overall efficiency of healthcare delivery and financial operations.

Veradigm AccelRx offers a complimentary, automated, all-encompassing solution designed to optimize the fulfillment of specialty medications for your patients. By reducing the time it takes to initiate therapy, this system can improve medication adherence and patient outcomes, while also minimizing the administrative burden of phone calls and faxes on your team. AccelRx integrates electronic enrollment, consent, prior authorization, and prescriptions into one seamless platform, enabling your practice to greatly decrease the fulfillment time for specialty drugs across all payers. With just a click, patient information is automatically filled in on enrollment forms and other necessary documents. This user-friendly platform serves as a transformative tool for managing specialty medications effectively. Furthermore, it enhances your ability to oversee a wide range of specialty drugs, including features for electronic prior authorization (ePA), all within your current electronic health record (EHR) system. This comprehensive approach not only streamlines processes but also supports better patient care and operational efficiency.

MediFusion offers a comprehensive suite of software that delivers cutting-edge EHR and medical billing solutions aimed at optimizing clinical, administrative, and financial functions within healthcare practices. Our dedicated team is always just a phone call away to provide continuous EHR training and support whenever you require assistance. Accelerate your clinical workflows and streamline your operations with our all-in-one integrated solution. This system effectively oversees the entire revenue cycle, encompassing everything from Eligibility Verification to Claim Processing and ensuring timely payments. Our cloud-based Electronic Health Record (EHR) software serves as a scalable and integrated solution, empowering your practice to enhance the quality of care delivered to patients. Designed for ease of use, this web-based EHR platform allows you to document, access, and monitor your clinical and financial data from any internet-enabled device, regardless of your location, ensuring you remain connected and efficient in your practice.

The Cohere Unify platform enhances all of our intelligent prior authorization solutions through the integration of touchless and predictive technologies, clinical content grounded in evidence, and various advanced features. By leveraging these technologies, we significantly minimize or completely remove the manual processes involved in achieving a comprehensive, fully automated prior authorization workflow. This predictive functionality allows health plans to nearly eradicate the traditional steps associated with prior authorization processes. Consequently, the system can autonomously generate tailored care plans utilizing patient and population authorization and claims data, which includes the ability to pre-approve multiple services before any requests are made. We employ evidence-based clinical criteria for specific specialties that complement our touchless and predictive technologies. Additionally, our platform features reliable single sign-on capabilities with widely used portals such as Availity and NaviNet. Furthermore, the configuration and implementation of rules have been validated to effectively manage transactions involving millions of cases, showcasing the scalability of our system. Ultimately, this innovative approach streamlines healthcare operations while enhancing efficiency and accuracy.

Cohere assists health plans in transforming their processes by integrating clinical intelligence, which facilitates comprehensive automation of prior authorization internally. Health plans can license Cohere's PaaS for intelligent prior authorization directly, allowing their utilization management teams to utilize it seamlessly. Consequently, client health plans experience notable improvements in administrative efficiency, alongside enhanced patient outcomes that are both quicker and more effective. Cohere offers a customized, modular solution suite specifically designed for health plans, streamlining all prior authorization requests into a cohesive, automated workflow. The platform automates decisions regarding prior authorizations based on the policies preferred by the health plans and accelerates the manual review process. It also aids clinical reviewers in handling complex requests with the help of responsible AI/ML and its automated features. By harnessing clinical intelligence through AI/ML and sophisticated analytics, Cohere enhances the performance of utilization management. Furthermore, it contributes to improved patient and population health outcomes through innovative programs tailored to specific specialties. This comprehensive approach positions Cohere as a leader in the health technology space, ensuring that health plans can meet their operational goals effectively.

Valer’s innovative technology streamlines and accelerates the processes of prior authorization and referral management by facilitating automated submissions, status checks, verifications, reporting, and EHR synchronization, all from a single platform that caters to mid-to-large-sized healthcare facilities, various specialties, and multiple payers. Designed to meet the specific needs of users, Valer stands out as a comprehensive solution that accommodates all specialties and payers, in contrast to generic products that often restrict specialties and service lines and lack automation for submissions. The platform's user-friendly interface boosts staff productivity, simplifies the training process, and monitors both staff and payer performance across diverse service lines, fostering an environment of ongoing enhancement. Valer goes beyond merely connecting with a handful of payers; it integrates seamlessly with all payers, ensuring compatibility across all specialties, service lines, and care environments, and provides real-time updates on payer rules to keep your operations current. With Valer, healthcare organizations can experience a revolutionary shift in how they manage prior authorizations and referrals, paving the way for improved efficiency and patient care outcomes.

With the increasing volume of Prior Authorizations and the added complexities introduced by specialty medications, Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) face significant challenges in adapting while striving to enhance both operational and clinical efficiencies. PAHub is a solution that is certified by HITRUST, providing comprehensive tools designed to streamline and govern all clinical, compliance, and administrative facets of Prior Authorization directly at the point-of-care, thereby enhancing compliance and decreasing turnaround times and costs. By utilizing cutting-edge technologies in data mining, analytics, content management, and sophisticated decision support frameworks, PAHub empowers clients to fully automate the entire prior authorization workflow. This innovative approach not only simplifies the process but also fosters a more efficient healthcare experience for both providers and patients. In an evolving healthcare landscape, solutions like PAHub are essential for organizations aiming to keep pace with the demands of modern medicine.

Easily and securely access a wide range of endpoints through a single API connection, eliminating the need to create individual solutions for various healthcare systems. This approach effectively bridges the divide between different systems, standards, and data sets, facilitating interoperability through a unified point of access. Consensus Harmony offers an array of universal healthcare APIs, cloud fax services, electronic signature tools, and connections to various EHR partners as well as other prominent industry cloud marketplaces. Users can enjoy versatile interoperability features that allow for seamless integration of digital faxing, secure messaging, patient record requests, e-signatures, and additional functionalities into essential workflows such as payments, prior authorizations, and referrals. By collaborating with community providers who are already integrated, you can enhance your capabilities and tap into new information networks. Our technology ensures that the method of communication remains flexible, allowing you to reach beyond traditional limits in your network. Embrace a future where connectivity and efficiency in healthcare communication are paramount.

The iMed e-Rx electronic prescription platform is available starting at $43 per month, allowing users to generate both legend and EPCS compliant prescriptions, and it holds certification for e-Prescribing across all states. In addition to its electronic prior authorization and formulary support features, the software offers significant advantages such as checks for drug-drug interactions, allergies, and disease interactions. Other noteworthy features include a regularly updated database of pharmacies, drug therapy monitoring capabilities, and continuous 24/7 oversight of prescription deliveries, ensuring a comprehensive solution for healthcare providers. With these capabilities, iMed e-Rx stands out as a robust tool for efficient and safe prescribing practices.