Sold by: Smile Digital Health
Smile Premium Applications are designed to enhance the payer-provider ecosystem, ensuring smooth prior authorization processes, and regulatory compliance. These solutions offer seamless data sharing, secure system
integrations, and automated workflows for improved healthcare delivery and operational efficiency.
Overview
Smile offers a comprehensive solution for the technical requirements of CMS-0057-F Interoperability and Prior Authorization Rule as well the capability to move beyond the mandate and deliver automation of the entire prior authorization workflow.
Access and Exchange: Patient Access API, Provider Directory API, Provider Access API, Payer to Payer API and Prior Authorization APIs (consisting of the CRD, DTR, and PAS modules) all adhering to the CMS required standards and HL7 Implementation Guides.
Prior Authorization Automation through Clinical Reasoning: For real-time coverage discovery, document requirements and adjudication, Smile Clinical Reasoning component leverages a content repository which has the medical policies and clinical practice guidelines codified in FHIR and CQL. For Coverage Discovery, if a prior authorization is required, the response will be automatic and presented in the form of a CDS card (Clinical Decision Support) which contains a link to the required documentation. The documentation will then be pre-populated with relevant information from the EHR via the FHIR specification. For Prior Authorization submissions, the FHIR data will be presented to the Clinical Reasoning engine to run against the FHIR content (payer policies in a FHIR decision tree) in real-time for approval or denial.
Smile Prior Auth solution can also integrate with existing downstream Utilization Management and Medical Necessity tools for review and approval.
Highlights
- Smile Digital Health CMS Suite is key to achieving compliance and automation
Details
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Delivery method
Deployed on AWS
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Pricing
Pricing is based on the duration and terms of your contract with the vendor. This entitles you to a specified quantity of use for the contract duration. If you choose not to renew or replace your contract before it ends, access to these entitlements will expire.
Additional AWS infrastructure costs may apply. Use the AWS Pricing Calculator to estimate your infrastructure costs.
Dimension | Description | Cost/month |
|---|---|---|
Per_Unit | Includes application hosting and support-Additional fees for storage | $4,167.00 |
Vendor refund policy
Smile is committed to the our client success and will provide the support required.
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Delivery details
Software as a Service (SaaS)
SaaS delivers cloud-based software applications directly to customers over the internet. You can access these applications through a subscription model. You will pay recurring monthly usage fees through your AWS bill, while AWS handles deployment and infrastructure management, ensuring scalability, reliability, and seamless integration with other AWS services.
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Implementation - Go-live faster with our streamlined implementation service - everything from system configuration to data migration.
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