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Coforge Introduces Authorization Rules Center (ARC) Solution for Healthcare Sector

Coforge

ARC solution empowers subject matter experts to directly author and maintain rules, while also offering intelligent tools and guidance to ensure flawless execution

Coforge Limited has launched ARC (Authorization Rules Center) for the healthcare industry, with the goal of reshaping the prior authorization process for health insurers and providers.

The prior authorization process has long been regarded as one of the most burdensome aspects of healthcare. Manual maintenance of authorization rules, disparate systems, and subjective decision-making results in high costs, inconsistent outcomes, reduced satisfaction levels, and limited scalability. ARC serves as a centralized rules engine, providing a connected, single source of truth for authorization rules. This powerful solution empowers subject matter experts to directly author and maintain rules, while also offering intelligent tools and guidance to ensure flawless execution. By connecting with any system that requires reference authorization rules, ARC provides real-time answers through APIs, eliminating the need for manual intervention and enhancing efficiency.

“Pega is a preferred automation tool for the healthcare industry and at Coforge, we have a large pool of Pega-certified architects to address the industry’s automation needs

Madan Mohan, Executive Vice President at Coforge

With ARC, healthcare organizations can easily address three key questions regarding authorizations: Does a service require authorization? Can a service be auto-authorized? What clinical criteria should be used to review a service? By centralizing authorization rules and putting maintenance in the hands of business experts, ARC revolutionizes the process, reducing high-cost manual touches, improving decision accuracy, and increasing satisfaction levels among providers, members, and internal staff.

Leona Rickerson, Vice President, Healthcare Solutions at Coforge, said, “We are excited to bring our domain and automation expertise to the prior authorization process with the launch of ARC.”

Madan Mohan, Executive Vice President at Coforge,said, “Pega is a preferred automation tool for the healthcare industry and at Coforge, we have a large pool of Pega-certified architects to address the industry’s automation needs.”

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