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The Prior Authorization process in healthcare is onerous, but the CMS Interoperability final rule mandates automation by January 2026. Coforge’s solution - ARC is a rules engine that centralizes and automates authorization rules, empowering experts to author and maintain them. It offers easy authoring, supportive intelligence, and seamless connectivity through APIs. ARC answers key authorization questions, improving accuracy, auto-authorization rates, and compliance while reducing costs and errors. This solution transforms authorization management, ensuring efficiency and traceability.
Content
ARC Solution Overview
Key Features
- Easy Authoring – Empowers subject matter experts to author rules with dynamic guidance and structure, bulk upload/download, effective and expiration dates, and reusable standard definitions
- Supportive Intelligence – Enables rules conflict identification and an automated testing suite, controlled publication workflows, searchable and exportable rules, complete audit trails, and utilization statistics.
- Connectivity – Delivers ready APIs for real time connectivity to any consuming system from Customer Service to External Portals, to UM processing tools, and interoperability standards
What does ARC Do?
- Centralizes authorization rules and puts maintenance directly into the hands of business experts
- Provides responses to three key questions:
- Does this service require authorization?
- Can this service be auto authorized?
- What clinical criteria should be used to review this service?
- Connects rules to consuming systems in real time
Business Benefits
- Increased ability to connect consumers and improved information accuracy resulting in a reduced number of contacts related to prior authorization
- Improved auto authorization rates resulting in decreased cost
- Reduced rework resulting from inaccurate information or decisions leading to lower costs
- Enhanced compliance and visibility resulting in reduced risk