ARC serves as a centralised rules engine, providing a connected, single source of truth for authorisation rules
Coforge,a global digital services and solutions provider, announced the launch of ARC (Authorization Rules Center) for the healthcare industry to transform the prior authorisation process for health insurers and providers.
The prior authorisation process has long been regarded as one of the most burdensome aspects of healthcare. Manual maintenance of authorisation rules, disparate systems, and subjective decision-making results in high costs, inconsistent outcomes, reduced satisfaction levels, and limited scalability. ARC serves as a centralised rules engine, providing a connected, single source of truth for authorisation rules. The solution empowers subject matter experts to directly author and maintain rules, while also offering intelligent tools and guidance to ensure flawless execution. By connecting with any system that requires reference authorisation rules, ARC provides real-time answers through APIs, eliminating the need for manual intervention and enhancing efficiency.
With ARC, healthcare organisations can easily address three key questions regarding authorisations: Does a service require authorisation? Can a service be auto-authorised? What clinical criteria should be used to review a service? By centralising authorisation rules and putting maintenance in the hands of business experts, ARC revolutionises the process, reducing high-cost manual touches, improving decision accuracy, and increasing satisfaction levels among providers, members, and internal staff.
Leona Rickerson, Vice President, Healthcare Solutions at Coforge, said, “We are excited to bring our domain and automation expertise to the prior authorisation process with the launch of ARC. ARC delivers a manageable, connected, single source of truth for authorisation rules that empower teams for success. Reducing prior authorisation friction will pave the way for positive transformation in the healthcare industry.”
Madan Mohan, Executive Vice President, Coforge, added, “Pega is a preferred automation tool for the healthcare industry and at Coforge, we have a large pool of Pega-certified architects to address the industry’s automation needs.”
He added, “At the recently concluded, PegaWorld iNspire 2023, the team showcased ARC, and it generated significant interest from the healthcare community. The ARC solution is also hosted on the Pega Marketplace.”
