Capgemini’s integrated solution addresses the complete lifecycle
Prior authorization is a process that lets providers and patients seek approval for medical services, prescriptions and medical supplies that are typically not covered by health plans, but can be authorized on an exception basis due to medical necessity and other planspecific criteria. Capgemini’s electronic prior authorization (ePA) solution enables electronic processing of the prior authorizations required for these types of exceptions.
Initially, Capgemini can implement a solution with electronic prior authorization requests and responses between providers, pharmacies and PBM/health plans. The initial installation will include the Electronic Guidebook Reference Tool. Successive versions of the solution can include an ePA for medical services and durable medical equipment (DME).