Myndshft is an end-to-end prior authorization (PA) and patient access software-as-a-service (SaaS) platform, now part of DrFirst, designed to automate and simplify complex administrative tasks in healthcare. The platform is notable for being the only unified solution in the industry that offers both medical and pharmacy prior authorizations, addressing a major pain point for providers and payers.
It is built on a foundational platform called CognitiveBus®, which utilizes generative AI, machine learning (ML), and robotic process automation (RPA) to automate processes, provide real-time insights, and determine the optimal submission route for PAs.
Key Benefits and Capabilities:
- Prior Authorization Automation: Automates the entire PA workflow from order to submission, verification, and status monitoring. The use of AI and automation can reduce manual effort by more than 70% and cut the authorization cycle time by up to 90%.
- Real-Time Benefits Verification: Instantly verifies patient eligibility and medical benefits for approximately 94% of U.S. covered lives.
- Patient Financial Responsibility: Automatically calculates co-insurance, copay, deductible, and other out-of-pocket costs at the point of service.
- Insurance Discovery & Coordination of Benefits (CoB): Identifies active coverage and can determine primary, secondary, and tertiary payers, even if not initially provided by the patient.
- Integration: Designed to integrate seamlessly with existing systems like EHRs, LIMS, pharmacy management, and revenue cycle solutions via HL7® FHIR® APIs.
Target Users: The software is used by healthcare providers (acute and post-acute care), payers, specialty pharmacies, Pharmacy Benefit Managers (PBMs), medical device manufacturers, and pharmaceutical manufacturers to improve patient experience, accelerate reimbursement, and boost staff productivity.
