MCG Health, part of the Hearst Health network and a provider of informed care strategies, has expanded its partnership with ZeOmega®, delivering Jiva 6.1, the end-to-end population health management platform. Together, the organisations offer a streamlined solution, MCG Cite AutoAuth integrated with Jiva from ZeOmega. This solution enhances payer-provider collaboration by automating the authorisation process while maintaining decision quality to support the timely delivery of effective care.
To ensure appropriate care and control costs, payers often require prior approval for certain procedures and services. Unfortunately, this process can be costly and time-consuming. According to a CAQH Index report, in 2015, 35 percent of prior authorisation requests were submitted manually (via phone, fax, or email) and cost payers $3.68 per transaction as opposed to just $0.04 per electronic transaction. The low adoption of electronic prior authorisations and the high cost of manual processing create organisational inefficiencies and highlight the need for an easy-to-use solution that automates this process.
MCG's evidence-based care guidelines and the MCG Cite AutoAuth solution seamlessly integrate within the Jiva Provider Portal from ZeOmega, allowing providers to submit and document prior authorisation requests within a single platform. Granting providers access to MCG's content reduces unwarranted clinical variation by ensuring interventions are evidence-based so patients receive appropriate care.
In addition, payers can set custom rules that allow providers to receive instant determinations (along with supporting documentation) for designated procedures and services. This limits the number of authorisations that require medical review and reduces time spent waiting on determinations, increasing both provider and patient satisfaction. The Jiva Provider Dashboards ensure ease of use and transparency when tracking requests - submitted, pending, and approved - with automated notifications delivered directly to the provider.
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