Cadalys, in partnership with the Health Services practice of PwC, is excited to announce the launch of an innovative prior-authorization automation solution powered by Cadalys CareIQ. This innovative platform integrates seamlessly with industry leaders like MCG, Salesforce Health Cloud, Salesforce Service Cloud, and, coming in 2025, ServiceNow's Healthcare and Life Sciences Service Management platform. Organizations that adopt the CareIQ Prior-Authorization solution are able to meet the highest regulatory and accreditation standards in healthcare. By enabling instant approval for most submissions and drastically reducing turnaround times for others, Cadalys CareIQ streamlines the prior-authorization process, offering providers an efficient and intuitive user experience.

Member and Provider Benefits

Cadalys CareIQ integrates MCG’s utilization management (UM) guidelines and organization-specific medical policies into a streamlined workflow. Leveraging a robust provider portal, business rules engine, and workflow automation capability to systematize both administrative tasks and medical necessity decision-making, enabling members to receive care more quickly and with higher quality.

Key features include:

• Instant Approvals: A significant number of prior-authorization submissions are eligible for instant approval without requiring human intervention, shifting clinician's focus from administrative tasks to higher-value cases where more clinical decision making is needed and not easily automated.
• Enhanced Clinical Workflow: Clinical team members will benefit from higher quality prior-authorization submissions due to improved data quality, optimized routing and prioritization, and streamlined communication, enabling them to make faster and more informed decisions prior-authorization submissions that are determined to not be eligible for instant approval
• Streamlined Provider Experience: A streamlined provider portal, integrated seamlessly into a comprehensive UM and care management (CM) platform with instant approval capabilities, enables providers to save a significant amount of time spent navigating the prior authorization process, and reallocate that time back to caring for their patients.
• Enterprise Integration: The prior-authorization solution is embedded within a comprehensive UM and CM platform, offering unparalleled user experience and significant efficiency gains.

Business Benefits

The prior-authorization process, which expanded significantly during the rise of Managed Care Organizations in the 1990s, has long been a bottleneck for healthcare efficiency. Automation through Cadalys CareIQ offers transformative benefits:

• Cost Savings: According to CAQH, electronic prior-authorization adoption could save the healthcare industry $449 million annually for providers and payers combined.
• Time Savings: CAQH has confirmed that electronic submissions reduce average processing times from 20 minutes (manual) to 12 minutes. Cadalys CareIQ’s advanced automation accelerates this trend even further.
• Regulatory Compliance: CMS estimates that mandated interoperability rules under CMS-0057-F will save provider practices $15 billion over the next decade.

About Cadalys CareIQ

Cadalys CareIQ is a clinician-friendly, AI-enabled and API-first clinical workflow solution focused on empowering clinicians and non-technical team members to configure and maintain clinical workflows in support of UM, CM and other important clinical workflows. It pre-integrates MCG and custom medical policies and content with leading platforms like Salesforce’s Health, Service and Sales Clouds, ServiceNow's Healthcare and Life Sciences Service Management platform (coming in 2025), and, via its powerful API, any other platform being utilized for facilitating UM, CM and other clinical workflows.

Designed for scalability, Cadalys CareIQ is future-ready, leveraging GenAI capabilities through both its native AI solutions and partnerships with industry leaders. By addressing inefficiencies in prior authorization, Cadalys CareIQ creates value for patients, providers, and payers alike—a true win-win-win scenario.

About Cadalys

Cadalys has been delivering clinical and IT service solutions for over a decade. With a track record of delivering focused value in the healthcare and high-tech industries, Cadalys is committed to empowering organizations worldwide through cutting-edge solutions that deliver superior business outcomes.