Informatics In Context

informaticsincontext.com

Informatics in Context's (IIC) is a cloud-based healthcare IT pioneer, delivering standards-based innovative solutions that streamline and automate the prior authorization and utilization review process for health plans. IIC's real-time automated prior authorization engine uses ACA's Electronic Data Interchange (EDI) 278 standard for medical outpatient procedures, inpatient, tests, labs, home care, and drugs covered under medical benefits. IIC’s 278 authorization engine is an end-to-end, real-time, and touchless automated prior authorization solution. It allows health plans to fully automate their UM process, with the ability to automate any clinical and business rule. The vast majority of actionable responses to providers is touchless, meaning they do not require human intervention on the provider or payer side. IIC is able to achieve a high level of touchless adjudication by automating all of the payer’s policies, patient benefit rules, clinical guidelines, and business and clinical rules required to return real-time actionable responses back to providers. Requests for documentation, attachments, and/or questions use the electronic EDI 275 daughter transaction. Using IIC’s cloud-based technology, health plans can immediately approve submissions that meet their established payment policies and care criteria, with no need for further review, or pend those that require manual review. Automating the PA process enables payers to realize an order of magnitude in time and cost savings per transaction, provides instantaneous actionable responses to providers, and allows health plans to expand provider requests to the higher volume, lower cost procedures without provider objection. IIC's PA solution is unique. Beyond being standards-based and fully automated, it provides agnostic integration with any payer or provider system, along with a configurable self-editor when guidelines require updating.