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skyAuth

Overview​

skyAuth for Payors streamlines the prior authorization review and decision process for health plans. It automates medical necessity reviews, reduces turnaround times, and improves consistency in authorization decisions.

Key Capabilities​

Automated Review

AI-powered medical necessity determination

Clinical Criteria

Apply evidence-based clinical guidelines consistently

Decision Support

Support reviewers with relevant clinical information

Features​

Automated Determination​

Apply clinical criteria automatically to straightforward cases, reducing reviewer workload.

Clinical Guidelines Integration​

Integrate with evidence-based guidelines like InterQual, MCG, and custom criteria.

Reviewer Workbench​

Provide reviewers with all relevant information in a streamlined interface.

Performance Analytics​

Track authorization metrics, turnaround times, and decision patterns.

Use Cases​

  • Medical Necessity Review: Automate routine medical necessity determinations
  • Utilization Management: Manage inpatient and outpatient utilization reviews
  • Pharmacy Authorization: Process prescription prior authorization requests
  • Appeals Processing: Streamline the appeals review process