Achieving AHIP's real-time approval target without compromising care
Reaching the AHIP commitment requires a fundamental shift in how health plans balance care quality, operational efficiency, and provider experience–one that maintains medical expense discipline while accelerating approvals.
January 1, 2027
AHIP's deadline for 80% real-time electronic approvals with FHIR API adoption across all markets. The window to build a thoughtful strategy is now.
Download the guide to learn:
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How legacy systems fall short
Portal-based platforms focus on transactions, layering AI/ML onto outdated infrastructure–resulting in inefficiencies and limited impact.
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Why clinical intelligence matters
Purpose-built platforms combine advanced technology with clinical expertise to reduce administrative burden and support evidence-based decision-making.
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How automation reshapes utilization management
Intelligent automation, transparent criteria, and advanced analytics enable health plans to improve provider satisfaction and streamline complex reviews.
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What a clinically grounded approach looks like
Explore the five principles that separate safe, sustainable automation from shortcuts that compromise quality or increase costs.
Who it’s for
Built for health plan leaders navigating the mandate
Health plan executives
Understand the strategic tradeoffs and organizational change required to hit the target, without sacrificing medical expense performance.
Clinical leaders
Get a framework for deciding which clinical services are candidates for real-time approval and which require continued review.
Operations & technology
Map your existing infrastructure against FHIR API requirements and identify the fastest path to compliance.
Medical management
Maintain utilization discipline as approval velocity increases across lines of business.
