Streamlining Prior Authorization in Healthcare Operations for Increased Efficiency and Compliance
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Meet our client
The client is a leading force in Healthcare Utilization Management Solutions, specializing in advancing and automating processes for Health Plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs). Their dedication is evident in enhancing care quality and expediting the delivery of critical healthcare services.
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An Application Modernization Case Study:
A healthcare solutions provider partnered with Zuci Systems to modernize their electronic prior authorization system, addressing compliance issues and improving operational efficiency.
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Business Requirement:
The challenges faced by the client in electronic prior authorization for medical benefit drugs include performance bottlenecks, complex user interface, scalability issues, security risks, and inadequate adaptation to user needs. These issues have contributed to:
- Compliance issues
- Extended processing times
- Escalating operational costs
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Despite these challenges, the client actively sought a comprehensive solution to address these issues associated with the Prior Authorization (PA) process. They needed a platform that utilized cutting-edge technologies to automate and enhance all aspects of the Prior Authorization process, especially to optimize the PA process at the point-of-care. Given these specific requirements, our client chose Zuci Systems as their preferred partner, recognizing our technical capabilities in developing advanced solutions for electronic prior authorization challenges.
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How Zuci Systems Helped:
Zuci Systems played a pivotal role in addressing challenges related to electronic prior authorization for medical benefit drugs, introducing pioneering eMPA capabilities, which include:
Technological Upgrades
- Transitioned from ASP.NET 4.2 to 4.8 and migrated to Angular, enhancing system capabilities.
- Leveraged Angular with TypeScript for frontend development, enhancing UI/UX and reducing the number of clicks.
- Utilized .NET Core for robust backend services, ensuring reliability and scalability.
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Architectural Enhancements
- Introduced a middleware API layer, streamlining communication between frontend and backend systems. This architectural shift facilitated future scalability and eased potential mobile development endeavors.
- Addressed issues with hardcoded values by introducing feature-level flags, which facilitated multi-tenancy and scalability. This strategy streamlined the management of electronic prior authorizations for diverse clients, ensuring smooth operations without performance bottlenecks.
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Development Methodologies
- Adopted agile methodologies, transitioning from a rigid waterfall approach to a more flexible and iterative development model. This approach allowed for continuous feedback loops and adaptation to evolving requirements.
- Enabled faster delivery of features and facilitated efficient resource allocation and strategic task prioritization through an intelligent Auto-Decision engine.
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User Experience Improvements
- Redesigned the UI/UX, focusing on improving responsiveness and reducing complexity.
- Introduced a user-friendly online platform, enhancing operational efficiency for users.
Security and Compliance Measures
- Implemented JWT token for enhanced security in API communication, ensuring secure authentication and authorization
- Ensured compliance with medicare guidelines through Continuous Compliance Surveillance Channels, showcasing proactive commitment to regulatory adherence.
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Tech Stack
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