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Streamlining Prior Auth Workflows Under the New CMS Rule

60 Minutes

Join industry experts for this timely and informative webinar to gain insights into how the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) and state-led initiatives are transforming the prior auth landscape.

There are many complexities encountered in processing prior authorization transactions between providers and payers. However, creating a transparent, efficient process is vital for high-quality patient care.

This presentation will take a deep dive into several critical stages of the workflow: verifying patient eligibility, understanding specific benefits, conducting provider lookups, and creating cases in the payer’s utilization management (UM) system. We’ll discuss the unique challenges, as well as the latest strategies and automated solutions for overcoming them.

Key topics will include:

  • The impact of the CMS Prior Auth Final Rule on healthcare providers and payers
  • Insights on how to streamline workflows for reducing administrative burdens, accelerating review times, and enhancing overall patient care
  • An exciting look at how AI and interoperability can lead to cost savings, improved compliance, and better alignment with healthcare providers
  • And more


Rajesh Godavarthi

Rajesh (Raj) Godavarthi

Raj Godavarthi joined MCG Health in 2003 and oversees a team that builds key interoperability solutions. Mr. Godavarthi is MCG’s primary representative in the HL7 Da Vinci Project. He has led efforts to support industry stakeholders in developing new HL7 FHIR standards which will allow for improved interoperability and communication between payers and providers. He is also a member of the WEDI Prior Authorization Subworkgroup and is working to improve health information exchange, enhance care quality, and reduce costs.

Daniel Cawood

Daniel Cawood

Daniel Cawood oversees the product development for MCG Health’s interoperability solutions as well as connecting payers and providers for authorization processes. Mr. Cawood began his time at MCG with a focus on the Indicia suite of solutions (provider market clinical decision support) and value-based care solutions. Before joining MCG, he was a Product Owner for Research & Development solutions at Optum Technology where he focused on using advanced technologies to solve operational, clinical, and business problems.

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60 Minutes