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+--- Thread: Mesh Health Solutions Partners with KONZA: Transforming Prior Authorization for Payer (/showthread.php?tid=2093)
Mesh Health Solutions Partners with KONZA: Transforming Prior Authorization for Payer - Chris Carter - 12-18-2024
Mesh Health Solutions, a leading provider of innovative solutions for the healthcare industry, today announced a strategic partnership with KONZA National Network, a nationwide Health Information Exchange (HIEs) and a Qualified Health Information Networks® (QHINsTM) under the Trusted Exchange Framework and Common AgreementTM (TEFCATM). This collaboration aims to streamline the Prior Authorization (PA) process, enhancing connectivity between payers and providers while aligning with the recent CMS final rule on Prior Authorization.
Through this partnership, Mesh Health Solutions and KONZA will leverage the advanced data exchange capabilities of HIEs and QHINs to automate and expedite PA requests. By utilizing this national data sharing infrastructure, the Mesh solution will enable seamless access to near real-time patient information. This infrastructure will reduce administrative burdens and improve the overall efficiency of the healthcare system. The CMS final rule emphasizes the importance of standardization and interoperability in the PA process, which this partnership will directly address.
“Prior Authorization has long been a source of frustration for providers and payers alike,” said Lauren Adams, CEO of Mesh Health Solutions. “Our partnership with KONZA is a significant step towards simplifying this process, allowing healthcare professionals to reduce the administrative burden associated with prior authorization and focus on what truly matters—patient care.”
The collaboration will support near real time data access and data accuracy while improving compliance with regulatory requirements, ultimately leading to better patient outcomes. With the combined expertise of both organizations, the partnership aims to redefine the standards for PA processing in the healthcare landscape, consistent with the objectives outlined in the CMS final rule.
“It will be nearly impossible to meet the 72-hour CMS rule for prior authorization decisions without leveraging the data-sharing infrastructure built by Health Information Exchanges (HIEs) and Qualified Health Information Networks (QHINs),” said Laura McCrary, EdD, President and CEO of the KONZA National Network. “Our partnership with Mesh will build on the significant work, effort, and funding invested in developing the national HIE and QHIN data-sharing infrastructure. Together, we will automate the antiquated process of copying, faxing, and making phone calls to obtain the necessary medical records.”
With provider consent, HIEs and QHINs will play a significant role in improving the prior authorization (PA) process in several keyways:
1. Interoperability: HIEs and QHINs facilitate the exchange of health information between different healthcare entities, allowing for seamless communication. This interoperability helps reduce delays in the PA process by providing real-time access to necessary patient data.
2. Data Accuracy: HIEs and QHINs focus on data quality and this helps to ensure that the information shared is up-to-date and accurate, reducing the chances of errors that can lead to denied or delayed authorizations.
3. Efficiency: HIEs and QHINs streamline workflows through the trusted exchange of health care data. Providers who opt-in to use the HIE and QHIN infrastructure can automate data retrieval and submission processes, reducing administrative burdens on providers and payers, and allowing for quicker decision-making in the PA process.
4. Standardization: HIEs and QHINs promote standardized data formats and protocols, making it easier for different systems to communicate. This helps align the PA process across various stakeholders, enhancing consistency and predictability.
5. Transparency: By providing only the data necessary for PA, HIEs and QHINs enhance trust and transparency in the process. Providers can better understand what is required for approval, leading to more successful submissions.
6. Improved Patient Outcomes: By expediting the PA process and reducing administrative delays, HIEs and QHINs help ensure that patients receive timely access to necessary treatments and medications, ultimately improving health outcomes.
7. Cost Reduction: Utilizing the infrastructure already built by the HIEs and QHINs will expedite the PA process by reducing manual faxing and phone triage for medical records that plague the current PA process. Reduced administrative burdens can lead to significant cost savings for both providers and payers, making healthcare more efficient overall.
About Mesh Health Solutions
Mesh Health Solutions is dedicated to transforming the healthcare industry through innovative technology solutions that enhance operational efficiency and improve patient care. Our mission is to streamline processes and enhance communication between providers and payers, leveraging advanced technology to improve patient outcomes and reduce administrative burdens in healthcare delivery. We specialize in innovative software solutions that facilitate efficient Prior Authorization (PA) processes, seamlessly integrating with existing healthcare systems to ensure effective communication and access to real-time patient data.
About KONZA
KONZA National Network advances health information sharing, enabling better care management, transformative value-based payment models, and actionable data analytics that improve patient outcomes. KONZA’s suite of products and services integrates with clinical workflows to provide seamless sharing of health data across networks and systems. As one of the first Designated Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common AgreementTM (TEFCA), KONZA is transforming access to comprehensive patient data.