CMS mandates prior authorization decisions within 72 hours. Orchestral's HAL Platform makes them immediate — seconds, not days. One API. Full compliance. Zero rebuilding.
Where CMS mandates 72 hours, HAL responds in under 10 seconds. Payer policy is matched against clinical evidence in real time — returning an immediate, auditable decision before the clinician leaves the screen.
HAL builds and operates all four FHIR APIs required by CMS — Patient Access, Provider Access, Prior Authorization, and Payer-to-Payer. Fully conformant with HL7 FHIR R4 and Da Vinci implementation guides.
Payer authorisation rules are loaded directly into HAL. Think of it as embedding the payer's rulebook inside the system — so when a PA arrives, it's matched against policy instantly, consistently, and with a complete audit trail every time.
HAL returns clinically-grounded denial reasons tied to the exact policy criteria that weren't met — never generic error codes. CMS requires this. HAL makes it automatic.
Built-in dashboards capture PA volume, decision rates, turnaround times, and denial reasons. CMS annual metrics submissions and public disclosure reports are generated automatically.
HAL sits alongside your existing claims and MMIS systems as a compliance layer. One API integration — no rip-and-replace, no multi-year transformation programme required.
Providers fax or phone each payer. Payer staff manually review clinical documents. Decisions take days. Everyone pays the cost in time, admin, and delayed care.
The HIE becomes the single point where clinical data and payer policy are matched in real time. Connect once. Work with everyone. Decisions in seconds.
HAL is pre-configured for Medicaid and Medicare PA requirements. Payer policy libraries include state-specific Medicaid authorisation criteria, updated continuously by Orchestral's clinical team.
HAL connects directly to Gainwell's MMIS and claims adjudication systems via FHIR. No rearchitecting — HAL operates as a compliance layer alongside your existing infrastructure.
Architected for high-volume government programs. HAL processes millions of PA transactions with 99.9% uptime SLAs, full redundancy, and HIPAA-compliant data handling throughout.
HAL generates the PA performance metrics CMS requires payers to publish annually — correctly formatted for submission and public disclosure, from day one.
Electronic PA submission and response using FHIR PAS IG — the Da Vinci standard
Member access to their own coverage, claims and PA status data via FHIR
Provider access to member coverage information and PA history at point of care
Exchange of member data when beneficiaries transition between plans or programs
Payer policy matched to clinical data in real time — decisions returned immediately with full audit trail
HAL auto-generates and formats required public disclosures for CMS submission
CMS now mandates prior authorization decisions within 72 hours. Orchestral's HAL Platform makes them immediate — under 10 seconds, end to end. A single API integration covers all four FHIR APIs CMS requires, embeds payer clinical rules (CQL) for real-time decisions, and auto-generates annual compliance reporting. Works for payers, providers, and — critically — Health Information Exchanges acting as the compliance hub between them.
We'll map HAL to your architecture and show a live PA decision.