Eligibility & Authorization Hub
Streamline prior authorization workflows with real-time eligibility verification, direct clearinghouse connections, and intelligent appeal management.
Complete Authorization Workflow
From eligibility verification to approval tracking, manage the entire prior authorization lifecycle in one unified platform.
Real-Time Eligibility Verification
Instant insurance eligibility checks with X12 270/271 EDI transactions. Verify coverage, deductibles, copays, and benefits before scheduling procedures.
Prior Auth Lifecycle Management
Complete workflow from request creation to approval, with status tracking, document management, and automated notifications at every step.
RPM/RTM/CCM Templates
Purpose-built templates for remote care programs with pre-populated CPT codes, diagnoses, and medical necessity language for faster approvals.
Intelligent Appeals Workflow
When auths are denied, our system auto-populates appeals with clinical justification, original diagnoses, and denial-specific templates.
Direct Clearinghouse Connections
Submit prior authorizations electronically through industry-leading clearinghouses for faster turnaround and real-time status updates.
Availity
Direct integration with Availity payer portal for eligibility and prior auth submission
Change Healthcare
Enterprise clearinghouse integration supporting major national payers
Supported Payers
Authorization Analytics
Live DataAuthorization Status Workflow
Authorization Templates for Remote Care Programs
Purpose-built templates for RPM, RTM, and CCM programs with pre-populated CPT codes, ICD-10 diagnoses, and medical necessity language. Plus imaging, PT, and DME templates.
RPM (Remote Patient Monitoring)
VitalEdgeCPT 99453-99458
- Blood Pressure Monitor
- Glucose Monitor
- Weight Scale
- Pulse Oximeter
RTM (Remote Therapeutic Monitoring)
VitalEdgeCPT 98975-98981
- Pain Management
- Respiratory Therapy
- Musculoskeletal
- Medication Adherence
CCM (Chronic Care Management)
VitalEdgeCPT 99490-99491
- Complex Care Plan
- Care Coordination
- Multi-Condition Management
Imaging
- MRI Brain
- MRI Lumbar Spine
- CT Scan
- Echocardiogram
Physical Therapy
- PT Short Term (12 visits)
- PT Extended (Post-Surgical)
DME & Procedures
- CPAP/BiPAP
- Knee Arthroscopy
- Joint Injection
Smart Suggestions
Templates suggested based on CPT codes, specialty, and payer requirements
Version Control
Immutable version history for compliance and audit requirements
Customizable
Clone and customize templates for your organization's specific needs
Built for Evolving CMS Guidelines
VitalEdge stays ahead of regulatory changes with USCDI V3 compliance, SDOH screening, and configurable billing programs that adapt to CMS updates without code changes.
USCDI V3 Compliance
Full US Core Data for Interoperability V3 implementation for EHR integration and information blocking prevention.
SDOH Screening
Social Determinants of Health data capture for CMS quality reporting and population health management.
SOGI Data Capture
Sexual Orientation and Gender Identity fields per USCDI V3 requirements for equitable care delivery.
CMS 2025/2026 Billing
Database-driven billing programs with configurable CPT codes, thresholds, and effective dates. No code changes needed for CMS updates.
FHIR R4 API
Full read/write FHIR R4 API endpoints for Patient, Observation, Condition, and MedicationStatement resources.
Multi-Region Ready
Feature flags for region-aware compliance (US CMS, UK NHS, AU) with 4-language internationalization support.
Regulatory Compliance Timeline
Automated Notifications & Alerts
Never miss an authorization update with configurable notifications across email, SMS, in-app, and push channels.
Authorization Analytics Dashboard
Track approval rates, denial reasons, turnaround times, and payer performance with comprehensive analytics and CSV export.
Summary Stats
Approval/denial rates, pending count
Payer Breakdown
Performance by insurance carrier
Denial Analysis
Top denial reasons and trends
Trend Charts
Monthly volume and approval trends
Reduce Authorization Turnaround by 60%
Join healthcare organizations using VitalEdge's EAH module to streamline prior authorizations and improve approval rates.