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Embedding Real-Time Prior Authorization into the Native EHR Workflow
Points of Light 2026 Case Study 19
Author
Mac Boyter
Author
Aurene Wilford
MedNOW Clinics, Centene, and athenahealth collaborated to replace manual, fragmented prior authorization processes with a standards-based, FHIR-enabled workflow embedded directly in the athenaOne EHR. Using the HL7 Da Vinci Burden Reduction implementation guides, the solution provides real-time insight into authorization requirements, network status, and member benefits at the point of order entry. The organizations worked closely to align technical specifications, CPT logic, and rollout strategy to ensure accuracy, scalability, and provider adoption. The alpha launch across 17 healthcare organizations—including MedNOW Clinics—delivered near-instantaneous determinations, reduced administrative burden and financial risk, and streamlined workflows and improved readiness for evolving regulatory requirements.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved Through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2026 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.