Portal & Access
Single digital front door for authorization checks, request submission, and clinical document uploads with real-time status tracking
Mastek Recognized as a Leader by Everest Group for AI-led Digital Transformation in the Mid-Market Segment.
Mastek wins the 2025 Oracle Regional Best in Class, Service Partner SaaS Applications, SCM Breakthrough Partner Award for EMEA at Oracle AI World!
Middle East Manufacturing Enters a New Digital Era - 62% of Manufacturers are now Investing in AI-driven Digital-first Strategies.
Mastek Recognized with the 'Voice of the Customer Honor – Value Excellence' Award at Everest Group Elevate Honors™ 2025.
AI-Powered Prior Authorization Solutions
Replace manual prior authorization workflows with an AI-enabled digital platform that supports real-time decisions, lowers administrative costs, and helps payers prepare for CMS FHIR-based electronic PA mandates by 2027
Automate Prior Authorization
Our Prior Authorization Solution for Healthcare Payers
We address the systemic inefficiencies of prior authorization, where 81.7% of appealed denials are overturned with a connected, digital-first platform offering. Our solution replaces inconsistent, manual rework with real-time, compliant processing across the entire authorization lifecycle, eliminating operational friction and driving peak efficiency for payer organizations
System Integration & EDI
FHIR-based APIs and EDI (278, X12 275) integration connecting provider submissions to utilization management, adjudication, and document systems
Regulatory Compliance Readiness
Architecture aligned to CMS 2027 electronic prior authorization mandates with support for public metric reporting and full digital audit trails
Performance Monitoring
Real-time dashboards tracking PA volumes, approval rates, rejection trends, and SLA performance to support operational control and reporting
Platforms & Accelerators for Electronic Prior Authorization
Our AI platforms, interoperability frameworks, and pre-built accelerators digitize the entire prior authorization lifecycle, reducing rework, improving decision accuracy, and enabling real-time, CMS-compliant workflows
Applies GenAI to streamline prior authorization by summarizing clinical data, supporting decision workflows, and automating provider-payer communication
Single digital front door for authorization checks, submissions, clinical document uploads, and real-time status tracking, eliminating fragmented workflows
Confirms authorization requirements before submission, reducing unnecessary requests and inbound calls with an under 2% system error rate at go-live
Validates provider identity in real time during submission, preventing downstream rejections with a 95%+ success rate at go-live
End-to-end orchestration of PA workflows using EDI 278 and X12 275 transactions, seamlessly connected to adjudication and document systems
Connects provider submission, EDI processing, utilization management, adjudication, and document management with no breaks in the workflow, ensuring CMS FHIR readiness
Real-time visibility into volumes, approval rates, rejection trends, and SLA performance, supporting operational control and CMS public reporting requirements
Prior Authorization Challenges We Solve
Healthcare prior authorization has evolved into a high-cost, high-friction process driven by manual workflows, inconsistent decisions, and increasing regulatory pressure, impacting care timelines, provider relationships, and compliance readiness
Administrative Burden & Cost
Manual intake, clinical reviews, and provider coordination drive high operational costs. Physicians handle 39 PA requests weekly, spending 13 hours, while 81.7% of denials are overturned, signaling avoidable rework
Delays in Care Decisions
Prior authorization slows treatment approvals, with 58% of members reporting delays or denials, impacting outcomes and increasing dissatisfaction
Provider Friction
Fragmented workflows, unclear requirements, and repeated follow-ups create friction across payer-provider interactions, reducing efficiency and trust
Compliance & CMS Mandates
CMS mandates FHIR-based electronic Prior Authorization by 2027, with real-time response requirements and public reporting already in effect, making compliance a near-term priority
Interoperability Gaps
Reliance on fax, phone, and disconnected systems limits real-time data exchange between payer platforms and provider EHRs
High Appeals & Rework
Inconsistent clinical decisions and incomplete data lead to frequent appeals, resubmissions, and peer reviews, driving operational inefficiency
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Mastek collaborates with leading technology innovators to deliver scalable digital, cloud, data, and AI transformation solutions for enterprises worldwide
Why Choose Mastek for Prior Authorization
Mastek delivers a fully integrated, AI-enabled prior authorization automation solution that eliminates manual workflows, improves decision accuracy, and ensures compliance with evolving CMS mandates
Get CMS-Ready Electronic Prior Authorization
Proven Reduction in Rework & Errors
End-to-End healthcare Prior Authorization Integration
Real-Time Authorization Decisioning
Provider-Centric Digital Experience
Built for CMS 2027 Compliance
What Differentiates Mastek in Prior Authorization
Mastek differentiates by fixing the root causes of healthcare prior authorization inefficiency, unnecessary requests, broken workflows, and inconsistent decisions, through real-time validation, end-to-end integration, and CMS-aligned architecture
Prior Authorization Solutions for Payers in North America
Payers reduce turnaround time by implementing real-time prior authorization workflows using APIs, eliminating manual intake (fax/phone), and enabling instant validation of authorization requirements before submission
Electronic prior authorization (ePA) replaces manual workflows with a digital process where providers submit requests via a prior authorization platform, which routes data through APIs and EDI (278/275) into payer systems for automated or near real-time decisions
CMS prior authorization compliance requires payers to implement FHIR-based APIs, support real-time responses for most requests, and enable public reporting of PA metrics by 2026–2027, making legacy workflows non-compliant
FHIR prior authorization APIs enable real-time data exchange between payer and provider systems, supporting functions like “Is Auth Required” checks, submission routing, and status updates, critical for automation and compliance
Prior authorization automation eliminates manual processing, reduces rework from incomplete submissions, minimizes call center volumes, and streamlines utilization management workflows, directly lowering administrative overhead
Payers improve experience by offering a single digital portal for submission, real-time status tracking, and upfront validation of requirements, reducing back-and-forth and administrative burden on provider staff
A complete prior authorization software for payers integrates provider portals, EHRs, EDI (278/275), utilization management systems, adjudication platforms, and document management systems into one connected workflow
Real-time decisions are enabled through prior authorization workflow automation, combining API-based validation (IAR), standardized clinical data exchange, and tightly integrated backend systems for instant processing
Transform Your Prior Authorization with Mastek
Move from manual, fragmented prior authorization workflows to a real-time, API-driven platform that reduces rework, accelerates decisions, and ensures CMS compliance
Talk to Our Prior Authorization Experts