Case Study
Prior Authorization Automation
The Situation
A multi-site provider organization with 20+ locations was facing a crisis that CMS-0057 was about to make significantly worse. Their PA denial rate sat at 30%. Approvals averaged 15 days. Administrative staff were consumed by manual entry across disconnected EMRs and payer portals. And January 2027 — the CMS deadline for electronic prior authorization — was on the calendar.
The challenge wasn’t awareness of the problem. It was execution. Legacy systems, siloed workflows, and the complexity of real-time data exchange between EMRs and payer systems had blocked every previous attempt at meaningful automation.
Implemented a full electronic prior authorization solution using CDS Hooks, SMART on FHIR, DTR, and PAS APIs — fully aligned to CMS-0057F specifications and designed to evolve with the regulatory timeline.
Automated PA triggers at clinical decision points within existing EMR workflows — eliminating manual entry at the source rather than patching it with a parallel process downstream.
Built real-time benefit verification that reduced incomplete PA submissions by 40% — catching errors before they reach the payer and eliminating the back-and-forth that extends approval timelines.
Talk to an Onyx expert about building ePA workflows that meet the CMS-0057 deadline — and keep working after it.
