Introduction

Oracle Health Intelligent Prior Authorization is a cloud-based application that provides both healthcare provider organizations (providers) and utilization management organizations (payers) with features to manage the prior authorization lifecycle.

For providers, the following functionality is included:

• A list of patients with outstanding prior authorization requests, along with status indicators is displayed.
• Logic to help providers understand if prior authorization is required for a patient's healthcare service.
• Necessary information to justify the medical necessity.
• Submit the request to the patient's health insurance.
• Receive responses for the prior authorization requests that are submitted for the patient.
• Assign tasks to yourself or others depending on your user permissions.
• The medical necessity status is displayed based on Centers for Medicare & Medicare Services (CMS), National Coverage Determination (NCD), and Local Coverage Determination (LCD) guidelines.
• View an AI-generated summary of prior authorization requests.