Machine learning-powered solution streamlines approvals, reduces delays, and lowers costs for payers and providers 

PLANO, Texas, Aug. 20, 2025 /PRNewswire/ -- ZeOmega^®, the leading population health management organization, today announced the launch of Smart Auth Optimizer, a machine learning-powered prior authorization solution for health plans that accelerates approvals, improves care access, and cuts costs while maintaining compliance and clinical oversight. The new tool integrates seamlessly into payer and provider workflows to streamline utilization management (UM) processes.

Prior authorization remains one of healthcare's most persistent pain points, creating payer-provider friction, care delays, and resource-intensive workflows. Smart Auth Optimizer addresses these challenges by using advanced analytics and machine learning to identify prior authorization requests that can be safely automated, generating real-time "likelihood to approve" scores for procedures and medications and applying those insights to auto approve prior auth requests. The solution package includes reports and dashboards to monitor utilization and incorporates safeguards such as audit and feedback reporting, AI fairness checks, and ongoing model performance monitoring and tuning.

Already deployed at a health plan owned by a large integrated healthcare delivery system, Smart Auth Optimizer reduced authorization turnaround times from 10 days to just three within seven months, alleviated backlogs, and reduced annual UM operational expenses by a projected 9% – equating to millions of dollars in savings. The technology also eliminated the need for "bulk approvals," an unsustainable practice used to meet Service Level Agreements (SLAs), which require authorizations to be processed within strict timeframes.

"These early results at a major health system validate the power and precision of Smart Auth Optimizer," said Pravin Pant, Vice President of Advanced Analytics at ZeOmega. "By combining data analysis, AI model development, and responsible deployment practices, Smart Auth Optimizer enables faster, more consistent decision-making and better experiences for payers, patients, and providers. The solution also helps plans stay ahead of regulatory changes like CMS's prior authorization requirements for transparency and turnaround times."

ZeOmega delivers Smart Auth Optimizer through a collaborative deployment model, working closely with each customer to tune the machine learning model to its data, configure automation rules, and track ROI through interactive dashboards and reports.

Leveraging our two decades of experience and data science with UM and care management, these models can be enabled at any health plan looking to optimize its pre authorization process by utilizing the latest in intelligent automation and augment their users in their existing workflows.

"Smart Auth Optimizer doesn't just automate prior authorization — it changes how organizations manage it," said Sadananda "Sada" Babu Rai, Co-Founder and President of ZeOmega. "By revealing patterns in authorization data, the solution helps clients make smarter decisions about where to focus resources and how to prevent care delays. It's built to evolve alongside regulatory changes and emerging industry standards, delivering sustained operational and clinical impact."

For more information about Smart Auth Optimizer, visit https://www.zeomega.com/solution-trends/smart-authorization-ai-solution. The case spotlight is available here.

About ZeOmega
ZeOmega empowers health plans and other risk-bearing organizations with the industry's leading technology for simplifying population health management. Clients using ZeOmega's Jiva Healthcare Enterprise Management Platform experience superior workflow and proven results due to exceptional integration capabilities, unmatched clinical content, and a powerful rules engine. With deep domain expertise and a comprehensive understanding of population health challenges, ZeOmega serves as a true partner for clients with personalized deployment and delivery models. By consistently exceeding customer expectations and project benchmarks, ZeOmega has earned a reputation for being proactive, reliable, and dedicated to improving the health of its clients' members. ZeOmega was named Best in KLAS for Payer Care Management Solutions in 2022, 2023, 2024, and 2025. Founded in 2001, ZeOmega is privately held and headquartered in Plano, Texas.

ZeOmega and Jiva are registered trademarks or trademarks of ZeOmega, Inc. or its subsidiaries in the United States and other countries. Other marks or brands may be claimed as the property of others.

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SOURCE ZeOmega