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CareOregon’s Strategy to Solve Prior Authorization Complexity Using Automated Workflows, sponsored by Edifecs, a Cotiviti Business

December 11, 2025 1:00 PM - 2:00 PM (EST)

Description

CareOregon faces a common challenge: streamlining prior authorization workflows in response to CMS-0057-F without investing in costly technology upgrades. 

In this session, Luke Ferrell, Enterprise Architect at CareOregon, will share his strategy to create a configurable, scalable, and compliant CMS-0057-F prior authorization solution. Luke will also discuss his vision of creating a unified prior authorization solution that reduces manual processes and accelerates care decisions. Luke will be joined by Ankur Nagpal, Senior Director of Product Management at Edifecs, who will highlight the unified gateway solution and key value proposition for Edifecs’ prior authorization platform. 


Key Takeaways

  • Strategies for government payers, commercial payers, and provider-led health plans to navigate CMS-0057-F requirements
  • CareOregon’s vision of streamlined prior authorization processing that leverages Edifecs’ ability to work seamlessly with other utilization management and policy management applications
  • Leveraging CMS-0057-F compliance to address additional payer challenges
  • How Edifecs’ unified gateway prior authorization solution enables scalable, rules-based automated workflows that adapt to evolving compliance and operational needs


Presenters:

  • Luke Ferrell, Enterprise Architect, CareOregon
  • Ankur Nagpal, Senior Director of Product Management, Edifecs, a Cotiviti Business



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WEDI
Name: Michael McNutt
Email: mmcnutt@wedi.org
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