Best Prior Authorization Software in Japan

For providers, medical necessity denials cost thousands to millions of dollars every year in write-offs, plus costly staff time researching and appealing denials and responding to patient concerns. For payers, the same is true on the other end of the claim management spectrum: Paying for medically unnecessary procedures and treatments – and time spent working on denial appeals – raises costs without improving outcomes. And of course, for the patient, there can be unnecessary copays and other out-of-pocket costs, not to mention a poor patient experience involving costs and moments of care they did not need. ABN Assistant™ from Vālenz® Assurance delivers the prior authorization tools providers need to validate medical necessity, print Medicare-compliant ABNs with estimated cost, and stop over 90 percent of medical necessity denials by verifying necessity before care is delivered to the patient.

MedicsRIS is a comprehensive radiology information system that empowers radiologists to seamlessly manage their practice and easily get paid for every diagnostic exam. Developed by Advanced Data Systems, MedicsRIS takes inbound orders from referring physician’s stage 2 certified electronic medical record (EMR) without any costly HL7 interfaces as well as obtain incentives and avoid penalties. Core features of MedicsRIS that help boost business productivity include a referring physicians portal, automated billing with EDI, multi-modality scheduling, insurance eligibility verification, mammography tracking, and more. Give referring physicians and radiology departments access to our qualified CDS option via the MedicsRIS portal for those who don’t have their own qCDSM. Stymied with getting prior authorizations manually? Our automated PA option gets them online without leaving MedicsRIS.

We’re accelerating innovative solutions created to benefit all stakeholders in healthcare, to help increase speed to therapy, reduce prescription abandonment and support improved health outcomes for the patient. We’re committed to removing access barriers to healthcare — whether it’s resolving prior authorization requests or raising awareness around support services. Healthcare is seemingly more expensive than ever. Assist your patients in getting their prescribed therapy with affordability solutions that help with high-deductible health plans, increasing copays and a lack of visibility. For some, staying on therapy can be the hardest part of their healthcare journey — whether it’s learning how to take their medications or simply remembering to do it at the prescribed time. Which is why these adherence challenges must be met with people-first solutions.

MDToolbox-Rx is a Certified, Award-Winning, complete electronic prescription writer that can run stand-alone or synced with your other office software. The e-Prescribing Software is a highly customizable, simple to use e-prescribing system that allows you to easily select drugs, find drug information, and create and electronically send a prescription quickly and efficiently. MDToolbox-Rx is Certified for e-Prescribing, Eligibility, Formulary, EPCS (e-Prescribing of Controlled Substances), and Electronic Prior Authorization. Search for drugs by name, nickname, generic, brand, rx, OTC, class or indication in the most comprehensive drug database available. Higher productivity due to less pharmacy calls and time spent for renewal requests.

PracticeAdmin Scheduling reduces no-shows and improves your patient interactions by providing the data you need on demand. Using our proprietary rules-based architecture, you can set up your own preferences — whether you’re a solo provider, small to medium sized organization or a provider with multiple locations. Create your own scheduling templates for an unlimited number of locations and set up automated patient reminders. Billing is your one stop tool to manage patient registration, claims and payment. You can track all of your patient information and prior authorizations. It integrates easily with your EHR and helps keep track of your Meaningful Use certification. Billing lets you know if your claim has an error before it’s sent. Quickly re-submit your claim with no penalty, and monitor all of your EDI rejections.

Experience a seamless workflow by having real-time transactions driven within existing technology platforms. Providers and Payers reduce time and effort by up to 90% for benefits and utilization management. Eliminate the current benefits and utilization management black box – eliminating confusion for patients, providers and payers. Self-learning automation and fewer clicks mean more time for patients, providers and payers to focus on care. Myndshft eliminates the quagmire of point solutions by providing a unified, end-to-end platform for in the moment payer-provider-patient interactions. Myndshft dynamically updates automated workflow and rules engines based on the actual responses and results from provider-payer interactions. Our technology continuously adapts to the rules in use by payers. The more you use it, the smarter it gets. A library of continuously-updated thousands of rules for national, state and regional payers.

Logix works in the background to complete tedious yet important workflow tasks like refill requests, prior authorizations, refill too soons, fax escalations, and phone call documentation. Other tasks, like fax and email, can be automated too. And you can alleviate human error on repetitive tasks as well. Plus, create notifications so you don’t forget what’s needed and can redirect time to focus even more on patients. Every keystroke and click counts! With Logix processes in place, you can reduce document handling & processing times by an average of 1-4 minutes per document. Logix is designed to work with DocuTrack to reduce keystrokes for your pharmacy workforce and make them more efficient. Reduce keystrokes needed to complete a process by up to 80 for some processes. How much can Logix save you? Use the calculator and see for yourself.

Rhyme connects payers and providers intelligently inside the prior authorization workflow, reclaiming the time lost on back-and-forth efforts and returning it to the patient. Automating manual tasks is critical (that’s why we do it), but it isn’t enough. When the nuances of clinical decision-making require collaboration between payers and providers, Rhyme keeps your workflow clear, agile, and fluid. We created the largest integrated prior authorization network, to leave a disjointed system behind and replace it with intelligent collaboration. Deep relationships and connections to EHRs, payers, and benefits managers, all on one platform. No scrambling, no screen-scraping, no secondhand info. We meet providers and payers right where you are, in your existing systems and workflows. Connections are easy so we can adjust to you, not the other way around. Prior authorizations aren’t an add-on to our platform, they’re all we do.

Leverage automation and intelligence to overcome patient access and revenue cycle challenges and increase reimbursements for patient care delivered. Despite the progress AI and automation is making in automating patient access and revenue cycle processes, there still remains a need for staff with RCM, clinical and compliance expertise to ensure patients seen were financially cleared and services rendered are accurately billed and reimbursed. We provide our clients with complete technology plus team coverage with deep knowledge of the complicated reimbursement landscape. Our technology and team learn from billions of transactions processed for leading healthcare providers and 1400 payers across the United States. Get quicker financial clearance for patients before care with our patient access plus a platform that provides complete coverage for obtaining eligibility verifications, benefit checks, patient pay estimates, and prior authorization approvals, all in one system.

Veradigm AccelRx delivers a free, automated, comprehensive solution to help you streamline specialty medication fulfillment for your patients. With faster time to therapy comes better odds for medication adherence and positive outcomes, as well as fewer phone calls and faxes for your staff. Combining electronic enrollment, consent, prior authorization, and script into an all-in-one system, AccelRx can help your practice significantly cut time-to-fulfillment for all specialty drugs, with any payer. Automatically populate patient data on enrollment and other forms with the click of a button. A single user-friendly platform to help you transform specialty medication management. Enhance your management of most specialty drugs all in one place, including electronic prior authorization (ePA). Access your enhanced specialty medication management as part of your existing electronic health record (EHR) workflow.

MediFusion is a fully integrated suite of software designed to offer innovative EHR and medical billing solutions to healthcare practices and enhance clinical, administrative and financial operations. Our team is just a phone call away to provide ongoing EHR training and be there for you whenever you need help and support. Speed-up your clinical processes and automate your workflow with our all-in-one integrated solution. A system that manages the entire revenue cycle from Eligibility Verification to Claim Processing and getting paid. Our cloud-based Electronic Health Record (EHR) software is an integrated and scalable solution to enable your practice to improve the quality of care provided to patients. This easy to use web-based EHR platform allows you to document, access and track your Clinical and Financial information on any internet-ready device no matter where you are.

The Cohere Unify platform supports all of our intelligent prior authorization solutions with touchless and predictive technologies, evidence-based clinical content, and other advanced capabilities. Our technologies reduce or eliminate manual steps toward creating an end-to-end fully automated prior authorization process. This predictive capability enables health plans to virtually eliminate prior authorization workflow steps. Instead, the system can automatically craft specific care plans based on patient and population auth and claims data, including multiple services that can all be pre-approved upfront before they are even requested. Evidence-based clinical criteria for select specialties that inform our touchless and predictive technologies. Proven single sign-on capabilities with Availity, NaviNet, and other common portal technologies. Rules configuration and deployment proven to scale over multi-million+ transactions.

Cohere helps health plans digitize the process and apply clinical intelligence to enable in-house, end-to-end automation of prior authorization. Health plans can directly license Cohere’s PaaS intelligent prior authorization for use by the plan’s internal utilization management staff. As a result, our client health plans achieve both significant administrative efficiencies and faster, better patient outcomes. Cohere delivers a tailored, modular, and configurable solution suite for health plans. Digitizes all prior authorization requests into a single automated workflow. Automates prior authorization decisions using health plan-preferred policies and accelerates manual review. Helps clinical reviewers adjudicate complex requests, using responsible AI/ML and automated capabilities. Leverages clinical intelligence with AI/ML and advanced analytics to improve utilization management performance. Improves patient and population outcomes with innovative, specialty-specific programs.

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large-sized healthcare settings, specialties, and payers from one platform and portal. Valer is the all-specialty, all-payer technology solution designed around your needs, not ours. Unlike off-the-shelf products that limit specialties, service lines, and payer mix (that don’t even automate submissions), Valer is explicitly customized to fit your needs. Because Valer is so easy to use, the dashboard increases staff productivity, simplifies staff training, and measures staff and payer performance across all service lines to enable continuous improvement. Valer doesn’t just connect to some of your payers for some of what you need. We link to all payers for all specialties, service lines, and care settings with real-time payer rule updates.

GenHealth.ai is a healthcare-focused generative AI platform built on a proprietary Large Medical Model (LMM) trained using data from over 100 million patient histories rather than natural language. The LMM processes medical codes and events to predict future patient trajectories, forecast costs, and simulate clinical pathways with higher accuracy and fewer hallucinations than traditional large language models. It supports a suite of purpose-built applications, including Intake Automation (PDF routing, data extraction, medical necessity), Prior Authorization Agent for automated adjudication, and G‑Mode analytics, which enables users to “chat” with historical and projected population‐health data via natural language, all without coding. This AI‑powered co‑pilot has shown 94 % accuracy in prior‑auth cases, a 120× improvement in medical loss ratio forecasting, and 110 % better cost prediction versus standard HCC scoring.

Silna Health’s Care Readiness Platform handles all prior authorizations, benefit checks, and insurance monitoring upfront to make sure patients are clear to receive care while providers gain capacity to focus on treatment. Its AI‑powered engine manages the entire prior authorization workflow, from tracking upcoming authorizations and sending weekly reminders to submissions and follow‑ups, automatically applying industry‑proven rules and escalating exceptions for human review. Specialty‑specific benefit checks verify coverage, accumulations, authorization requirements, and visit limits in real time, delivering accurate quotes at intake. Continuous insurance monitoring flags lost coverage, detects new plans, and safeguards against eligibility lapses. Designed for zero extra headcount, Silna ingests data directly from EMRs and practice management systems, offers configurable rule sets and strategic guidelines, and presents clear dashboards with incremental revenue insights.

As Prior Authorization volumes continue to rise, and as specialty drugs create additional clinical complexities, Health Plans, Pharmacy Benefit Managers (PBMs) and Third-Party Administrators (TPAs) are challenged to adapt while maintaining or improving operational and clinical efficiencies. PAHub, is a HITRUST certified solution that puts the tools at your fingertips to streamline and control all clinical, compliance and administrative aspects of Prior Authorization at the point-of-care to improve compliance, reduce turn-around times and costs. By leveraging the latest technologies for data mining, data analytics, content management and advanced decision support trees, PAHub, enables customers to automate the end-to-end prior authorization process.

Access numerous endpoints, securely and simply with one API connectivity and avoid developing one-offs to disparate healthcare systems. Bridge the gap between multiple systems, standards, and data sets, using a single point of access for developing interoperability. Consensus Harmony includes universal healthcare APIs, cloud fax APIs, electronic signature APIs, and connectivity to multiple participating EHR partners and other leading industry cloud marketplaces. Flexible interoperability options to programmatically integrate digital faxing, secure messaging, patient record requests, e-signatures, and more into key workflows like payments, prior authorizations, and referrals. Extend your capabilities and access new information networks by partnering and leveraging community providers already integrated. Don’t limit the network you communicate with, leave the modality of communication up to our technology.

Save time with templates and patient charts in the cloud-based EHR that adapt to your needs. Browse from a library of medical charting templates built by practices like yours. Efficiently manage prescriptions including controlled substances and those requiring prior authorization. Seamlessly exchange information with local pharmacies, laboratories, imaging centers and other tools integrated into the EHR platform. Choose from over 500 lab and imaging centers to order tests and share results with patient. Flexible billing options with industry-leading partners who help you get paid faster. Monitor your progress with insightful dashboards and submit reporting data to CMS directly through your EHR. Access customizable dashboards to track your progress on quality initiatives like MIPS. Explore extensive education and training materials to navigate the complexities of quality measures.

The financial and administrative challenges facing healthcare providers are daunting. Waystar’s technology platform simplifies and unifies healthcare payments across the revenue cycle. We empower healthcare organizations to automate manual work, gain insight into processes and performance, and ultimately collect more revenue. At Waystar, we know there’s a better, more efficient way forward. Let’s climb the mountain ahead of us to reach new heights in healthcare. We know that adopting new revenue cycle technology can seem like an obstacle. Whatever your existing systems, our cost-effective technology is compatible and gets up and running quickly. Our single sign-on platform lets you manage commercial, government and patient payments all in one place, so you can consolidate vendors and eliminate the hassle of multiple systems. Give your staff intuitive solutions that will make their jobs easier and their workflows more productive.