Removing the Admin Burden of Prior Auth
Our “Mesh-ion” and Vision
At Mesh Health Solutions, our goal is ensuring your members have the timely access to the care they need by reducing the burden of 600M annual medical prior authorizations. We like to call it our “mesh-ion” and vision, and it drives everything we do.
Our Story
Mesh Health Solutions is a healthcare information technology company addressing the challenges of medical prior authorization (mPA) for health plans. Mesh is a tech led organization with more than 30 years of combined utilization management experience, and Mesh’s diverse leadership team boasts expertise across business, clinical, and technical disciplines. This varied background is a significant asset, enhancing Mesh’s in-depth understanding of the mPA landscape and fostering an innovative approach to addressing its challenges.
Most mPA pain points are a result of time-consuming steps in manual submission or processing workflows. Rather than solve these problems with additional staff, we’re committed to applying technology at the right places in your workflows to reduce the administrative burden of mPA. Mesh provides capabilities that allow for omni-channel intake of information from a multitude of sources including fax, electronic health records, EDI, and provider portals. Our technology enables automated request intake, case build, triage, and models to support more efficient case evaluation. Our aim is to automate the manual steps a machine can do, and accelerate the manual steps a person must do.
Mesh is gaining traction in assisting payers with costly and time-consuming manual mPA workflows. As of January 2024, CMS released the Interoperability and Prior Authorization Final Rule, to support standards via HL7 FHIR by January 1, 2027, and Process improvements by January 1, 2026. Implementation of a new standard will enable a more streamlined workflow and transparency. However, getting to a fully automated workflow takes time, requiring widespread adoption and technical readiness across the industry. Mesh is focused on addressing current manual mPA processing issues while also planning for future FHIR standards, enabling our clients to pivot to digital workflows behind the scenes, driving program optimization and efficiencies.