Prior Authorization

Prior authorization is a core function of an ABM solution. In some instances, customers will delegate prior authorization reviews to Optum and its ABM partners. In others, the customer will retain this function but enabled by Optum through our proprietary tools and technologies. Regardless of whether a customer purchases a delegated or non-delegated ABM solution, Optum will provide value to our ABM partners, customers, and Optum by:

Serving as a single point of data integration for the customer
Standardizing and streamlining customer implementations
Enabling new capabilities and faster innovation
Facilitating prior authorization to claim matching editing via CES
Enable comprehensive product performance and customer reporting to include prior authorization-related metrics

To deliver this value, the Optum ABM prior authorization data service will have the following capabilities:

Cloud-based, configurable infrastructure, including data processing pipelines, data storage, logging and monitoring, security, and CI/CD
Multiple data transmission methods and formats for our ABM partners and customer, including batch, real-time, sFTP, and APIs
ABM API gateway for easy ABM partner and customer access to our APIs
Prior authorization common data model for receiving, transmitting and storing prior authorization data
API-based integration with CES to enable real-time prior authorization to claims matching integration
Business intelligence and customer savings reporting enablement (e.g., Tableau integration)

How to try an API?