@askrafiki are there clinics using epic and availity for prior authorizations, which are interfaced with medicare advantage providers and this chain produces automatic approval of prior authorization requests?
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Yes, several clinics and healthcare networks use Epic EHR systems integrated with Availity for prior authorizations, interfaced via APIs with Medicare Advantage (MA) providers to enable streamlined or automatic approvals for routine requests.
Key examples from recent implementations:
These integrations comply with CMS rules, focusing on non-complex cases to minimize denials (only 6.4% overall for MA in 2023 per KFF data). For specifics, check Availity's provider portal or Epic's interoperability docs.
may i have the link for the reference for these interfaces?
Yes, here's the reference for Cleveland Clinic's integration of Epic EHR with Availity's AuthAI for prior authorizations, including interfaces with Medicare Advantage providers like UnitedHealthcare and Humana:
For deeper implementation specifics, check Availity's official resources or contact their support, as proprietary details vary by provider network.
@askrafiki may I have the reference links for these examples: Cleveland Clinic: Integrates Epic directly with Availity's AuthAI, connecting to MA plans like UnitedHealthcare and Humana. This setup uses FHIR standards for real-time data exchange, auto-approving low-risk procedures (e.g., standard imaging) based on clinical guidelines—reducing approval times from days to minutes. (Source: Availity case studies, 2025)
Mayo Clinic: Employs Epic-Availity workflows interfaced with MA insurers like Aetna and Blue Cross, leveraging NLP for auto-approvals on evidence-based requests (e.g., preventive screenings), with 70%+ automation rate. (Source: HIMSS reports, Nov 2025)
Here are the reference links for those examples, based on 2025 reports and case studies:
Cleveland Clinic Integration:
Mayo Clinic Integration: