Skip to content
Search to learn about InterSystems products and solutions, career opportunities, and more.

Improving the Speed and Transparency of Authorizations through FHIR API–Enabled Data Sharing

KLAS Research: Points of Light Case Study

Executive Summary

KLAS points of light badge

Prior authorizations for referrals and clinical procedures are widely acknowledged as a significant pain point for all involved parties—payers, providers, and patients. Using implementation guides from HL7’s Da Vinci Project, the collaborators in this case study created bidirectional data exchange through a FHIR API that enables an automated, in-workflow authorization process. The pilot use cases have been successful, achieving improved efficiency, reduced costs, and—most critically— more timely care and improved patient outcomes.

Points of Light—Outcomes Achieved through Collaboration
  • Improved efficiency through automated workflows that facilitate timely authorizations for therapeutic Botox treatments
  • Improved processes and governance for both parties
  • Cost savings for both parties through significant reduction in manual processes
  • Improved patient outcomes via more timely access to care
  • Three-year CMS exemption that allows electronic data to be transferred as FHIR bundles rather than the standard, HIPAA-required X12, 275, and 278 transactions

Download the KLAS Research Points of Light Case Study to learn more about the collaboration between UC Davis Health, a Payer Organization, and InterSystems, Including:

  • Points of Friction—Challenges to Be Solved
    • High administrative costs associated with labor-intensive authorization processes
    • Siloed workflows and lack of transparency between payers and providers create churn and delay care
  • Action Plan—How the Collaborators Worked Together to Reduce Friction
    • Partnered on a pilot to automate authorization requests and approvals for therapeutic Botox treatments
    • Identified mutual business goals and success metrics
    • Established bidirectional, in-workflow data sharing between the payer and provider organizations
    • Obtained three-year CMS waiver exempting the collaborators from HIPAA requirements for electronic transactions
  • Lessons Learned—What Best Practices Can Other Organizations Replicate?
    • Develop a collaborative statement of work that includes all stakeholders (payer, provider, and IT vendor)
    • Start with a pilot and be clear about the commitment and availability of financial and human resources
    • Benefits can be gained without adding to already onerous administrative burdens
  • What’s Next?—Vision for the Future
    • Identify additional use cases and payer/provider partners
    • Prove to CMS that the project has reduced the administrative burden
    • Build a consent model

Other Resources You Might Like

Oct 09, 2025
Fact Sheet
InterSystems IRIS and IRIS for Health Managed Service assists customers that want to focus on their core business and innovate faster, and have InterSystems manage all of the provisioning, operation, and maintenance of our InterSystems IRIS software and the supporting cloud infrastructure.
Oct 09, 2025
Market Note
This TabbFORUM report explores how AI is moving from cool novelty to core infrastructure, what’s working in production today, and where the next wave of adoption will determine lasting competitive advantage.
Oct 06, 2025
IDC MarketScape
InterSystems is positioned as a Leader in the IDC MarketScape for EMEA. Healthcare Data Platform for Providers 2025 Vendor Assessment
Oct 03, 2025
Industry Insights
GenAI, Large Language Models, and Natural Language Processing are Fundamentally Transforming Healthcare
Oct 03, 2025
HIMSS Market Insights
HIMSS Market Insights conducted this research, sponsored by InterSystems, in April and May 2025 among leaders in MedTech organizations to understand their perspective on integration solutions and efforts. We looked at:
Oct 03, 2025
Fulfillment
InterSystems Supply Chain Orchestrator unifies data from thousands of disparate sources, giving you real-time visibility and prescriptive insights across your entire supply chain. With GenAI-powered decision intelligence, you can optimize replenishment, adapt to live conditions, and deliver near-perfect OTIF performance. For over 45 years, InterSystems has helped businesses unlock value from data—quickly, safely, and at scale.
Oct 03, 2025
Inventory Optimization
InterSystems Supply Chain Orchestrator unifies data from thousands of sources to help you anticipate disruptions, forecast smarter with AI, and make the right decisions in real time. With GenAI-enabled Copilot guidance, you’ll minimize overstocks and stockouts while keeping customers satisfied. For over 45 years, InterSystems has helped businesses unlock value from their data—quickly, safely, and at scale.
Sep 29, 2025
ISG Research
This Ventana Research Buyers Guide: Data Platforms is an assessment of how well software providers’ offerings address enterprises’ requirements for data platforms software, evaluating software in seven key categories that are weighted to reflect buyers’ needs based on expertise and research.
Aug 27, 2025
Supply Chain
Gain Intelligent Supply Chain Visibility
Aug 09, 2025
EMC Healthcare
Mr Jusup Halimi, CEO, and Dr Bella Desra Andae, Medical Informatics Specialist, at EMC Healthcare describe their EHR journey with InterSystems – implementing a unified EHR across eight hospitals in 18 months to moving to an AI-powered EHR system.

Take The Next Step

We’d love to talk. Fill in some details and we’ll be in touch.
*Required Fields
Highlighted fields are required
*Required Fields
Highlighted fields are required

By submitting your business contact information to InterSystems through this form, you acknowledge and agree that InterSystems may process this information, for the purpose of fulfilling your submission, through a system hosted in the United States, but maintained consistent with any applicable data protection laws.



** By selecting yes, you give consent to be contacted for news, updates and other marketing purposes related to existing and future InterSystems products and events. In addition, you consent to your business contact information being entered into our CRM solution that is hosted in the United States, but maintained consistent with applicable data protection laws.