With the CMS-0057-F ruling mandating new requirements around prior authorization and healthcare data exchange APIs, as well as the more recent emergence of additional state regulations, VirtualHealth® and Itiliti Health are pleased to announce the launch of a single-solution platform capable of supporting healthcare payers’ needs for prior authorization, CMS compliance, and FHIR® APIs.
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The new HELIOS + Itiliti Health platform will not only help healthcare payers meet evolving regulations for prior authorization and interoperability, but it will provide the industry-leading HELIOS platform to support cost-effective and streamlined care management, disease management, population health, and additional utilization management needs such as concurrent and retrospective authorizations, appeals, and grievances.
“Itiliti Health has been an incredible partner for VirtualHealth, and we saw an opportunity to work more closely together to answer the need for an integrated care management, utilization management, and prior authorization solution that we saw in the industry,” said Sue Powers, Chief Growth Officer. “This new HELIOS + Itiliti Health solution will help payers meet the evolving federal and state requirements for prior authorization and interoperability all while helping them to achieve technical alignment, reduction of operational and tech-stack costs, and improvement of care delivery and outcomes.”
Potential ROI for HELIOS + Itiliti Health Solution Customers:
- Millions of dollars saved in administrative costs annually
- More than 93% increase in care team efficiency and productivity gains
- Near elimination of prior authorization disputes and unnecessary submissions
- Faster closure of critical care gaps
- 80% faster bi-directional data delivery
Key Features of the HELIOS + Itiliti Health Solution:
- Industry-leading rules engines for enterprise-wide efficiency and automation
- Out-of-the-box, clinically-vetted workflows for CM and UM
- Best-in-class platform design that’s quick and easy to use
- Automated, concurrent, and retrospective authorizations
- Integrations for fax, EHR, and other provider systems
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Itiliti Health’s best-in-class suite of products including:
- PA Checkpoint™: Is Auth Required? and Policy Transparency
- Policy Management
- Prior Authorization Routing
- Automatic Authorization Rules
- Clinical Decision Assistant
- Configurable assessments, care plans, letters, tasks & more
- Provider, Member, and Caregiver Portals
- Certified with Change Healthcare’s InterQual and MCG’s clinical guidelines, providing evidence-based criteria for authorizations
- HITRUST CSF certified, HIPAA- and HITECH-compliant, NCQA pre-validated for population health management
- Quick implementation times
- Role-based access control for users
- Advanced reporting, analytics, and insights with intuitive dashboards and tools for everything from episodes, tasks, risk, referrals, appeals, grievances, and more
“HELIOS + Itiliti Health delivers a solution that stands at the forefront of ensuring compliance with critical federal and state regulations, including CMS 0057-F,” said Michael Lunzer, Founder and CEO of Itiliti Health.“This new shared solution will enable healthcare payers to lower costs by eliminating unnecessary manual processes and proactively identifying members’ needs, simplifying care and utilization management, and streamlining operations to drive better health outcomes and high-quality, equitable care.”
Contact VirtualHealth’s Sue Powers (sue.powers@virtualhealth.com) to learn more about this new single-solution platform for integrated care management, utilization management, automated prior authorization, and FHIR®.
About VirtualHealth
VirtualHealth is dedicated to empowering healthcare organizations to provide the exceptional value-based care that members need to change their lives for the better. To do this, VirtualHealth created the industry-leading medical management platform HELIOS® to meet the needs of government health plans, commercial payers, health systems, and specialty providers. Trusted by some of the largest and most innovative healthcare organizations, HELIOS supports care and disease management, population health, utilization management, FHIR data interoperability, and more. Unrivaled in the industry with 90% configurability, HELIOS utilizes AI, powerful automations, and unlimited clinical workflows and integrations to enable faster and more effective care. Intuitive and easy to use, VirtualHealth’s solutions help remove provider-payer frictions, lower operational and administrative costs, and drive productivity and efficiency gains, all while maintaining compliance. To learn more, visit www.virtualhealth.com.
About Itiliti Health
Through our innovative solutions, Itiliti Health is at the forefront of transforming the prior authorization landscape. By eliminating unnecessary manual processes, implementing automation, and streamlining operations, we significantly reduce administrative burdens and operational and clinical costs. Our approach not only enhances efficiency and creates significant cost savings for payers but also improves the satisfaction of healthcare providers and patients alike, making the entire healthcare delivery system more effective and responsive.
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