TriZetto Provider Prior Authorization Solution

TriZetto Provider Prior Authorization Solution streamlines the prior authorization process by integrating real-time payer data and workflow guidance directly into EHR systems. It automates approvals, reduces administrative burden, and improves provider efficiency while minimizing burnout. By implementing FHIR interoperability standards, it aligns payer-provider workflows, reducing disputes and enhancing collaboration.

The solution uses three key FHIR-based APIs: CRD instantly identifies if prior authorization is needed; DTR gathers required documentation via HL7® FHIR® questionnaires; and PAS enables digital submission and real-time status updates. These APIs accelerate approvals, improve transparency, and enhance patient care. Replacing outdated tools like fax and portals, TriZetto ensures compliance with regulatory standards and transforms EHRs into active enablers of outcomes and reimbursement.

Providers using TriZetto Provider Prior Authorization Solution benefit from:

• Reduced costs and the burden of cumbersome prior authorization request
• Improved accuracy and increase turnaround time for authorization approvals
• Increased speed to care