Streamline electronic prior authorization - Redox
Streamline electronic prior authorization
Cut the admin burden of prior auth. Redox automates data exchange, reducing manual work and speeding up care decisions.
Meet CMS requirements with confidence.
Current prior authorization workflows are slow, manual, and error-prone–leading to frequent denials that drive up costs and delay critical care. By January 2027, CMS requires many health plans to implement a Prior Authorization API that supports electronic submission of requests, documentation, and decisions—enabling fully digital prior authorization workflows.
Redox helps you stay modern and compliant, while realizing significant cost savings. With fully electronic processing, CAQH estimates you will save $3.47 on every transaction, which can add up to millions in annual savings for most payers. This is a true win-win for everyone, especially your members who will get the care they need, faster.
Case study
Blog post
Redox-integrated workflows reduce prior authorization turnaround times by as much as 60%
A tangled web of clinical and administrative data spread across disparate systems makes informed prior authorization decisions daunting. This case study explores how Redox is untangling the web — connecting payers, providers, and vendor solutions.
How it works
Redox enables true end-to-end electronic prior authorization between payers and providers. By embedding prior authorization solutions directly into provider electronic health record workflows, Redox eliminates cumbersome fax and web portals. Redox translates X12 messages to HL7® FHIR® (and back again) following Da Vinci implementation guides to ensure forward and backward compatibility and compliance.
See our prior authorization use case in action
HL7® is a registered trademark of Health Level Seven International. The use of this trademark does not constitute an endorsement by HL7.
FHIR® is a registered trademark of Health Level Seven (HL7) and is used with the permission of HL7. Use of this trademark does not constitute an endorsement of products/services by HL7®.