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Pega Google Prior Authorization Integration

Pega Care Management and Google Claims Acceleration Suite: Streamline prior authorization process

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Three steps to reinventing prior authorization processing to reduce friction and drive a more efficient process:

  1. Streamline approvals while improving experiences for employees and providers by eliminiating silos, redundancy, and delays in workflows – using tools that ensure everyone is operating at the top of their training.
  2. Provide ready access to digitized structured information for the case manager doing the review. Automatically connect to clinical information and eliminate countless steps and staff hours spent assembling, handing off, and redundantly validating information.
  3. Automate approvals. When straight-through processing is not available, workflows can be configured to provide comprehensive information needed to understand each request in its context and focus attention to streamline responses.

Key Features

  • Automated Prior Auth intake integration with the FHIR Store on Google Claims Acceleration Suite
  • Smart validations for eligibility and auto-authorization business rules
  • Streamline supporting documentation collection and review process
  • Integration with industry-leading evidence-based clinical guideline providers for medical reviews
  • Automated letter generation and notifications
  • Automated potential duplicate identification
  • System enforced SLA / TAT driven processing
  • Deliver up-to-the minute, accurate, and compliant prior authorizations and documentation




Compatible with

Pega Platform 8.8


Kenny Smith

Last updated

April 11, 2023
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