Change Healthcare Prior Authorization
Prior authorization software
Health care software
Health care operations software
- Features
- Ease of use
- Ease of management
- Quality of support
- Affordability
- Market presence
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What is Change Healthcare Prior Authorization
Change Healthcare Prior Authorization is a healthcare operations solution that supports electronic prior authorization (ePA) workflows between providers, payers, and other transaction partners. It is used by provider organizations, revenue cycle teams, and health plans to initiate, submit, and track authorization requests and related clinical documentation. The product focuses on automating administrative steps and enabling connectivity through standards-based transactions and integrations with clinical and revenue cycle systems.
Strong payer-network connectivity
The product is designed to connect providers and payers for prior authorization transactions at scale. It supports electronic exchange of authorization requests and status updates, which can reduce reliance on phone, fax, and manual portals. This connectivity focus aligns with enterprise healthcare transaction networks commonly used in claims and eligibility workflows.
Workflow automation and tracking
It supports end-to-end authorization workflows, including request creation, submission, and status tracking. Centralized tracking helps operational teams monitor turnaround times and follow up on missing information. Automation can reduce repetitive data entry and improve consistency in how authorizations are processed across sites and service lines.
Integration with clinical and RCM systems
The product is commonly positioned to integrate with EHR and revenue cycle environments to streamline data capture and reduce context switching. Integrations can help pre-populate request details and attach supporting documentation more efficiently. This is particularly relevant for organizations that need prior authorization embedded into scheduling, ordering, or billing workflows.
Enterprise orientation and cost
The product is typically aligned to enterprise-scale healthcare operations and transaction volumes. Smaller practices may find the total cost of ownership higher than simpler prior authorization tools embedded in practice management systems. Contracting, governance, and change management requirements can also be heavier than for point solutions.
Implementation can be complex
Deployments in large provider or payer environments often require integration work, mapping, and workflow redesign. Configuration may vary by payer, service type, and local operational processes, which can extend timelines. Organizations with limited IT resources may find setup and ongoing optimization demanding compared with lighter-weight tools.
Coverage varies by payer and service
Electronic prior authorization effectiveness depends on payer participation and the specific services supported for electronic submission and responses. Some requests may still fall back to manual processes when payers require proprietary portals, additional forms, or non-standard documentation. As a result, organizations may need parallel workflows to handle exceptions.
Plan & Pricing
| Plan | Price | Key features & notes |
|---|---|---|
| Digital Auth Complete (prior-authorization automation; Optum / Change Healthcare offering) | Custom / Contact sales (no public pricing listed on product page) | AI-powered prior-authorization automation, EHR integration, multi-channel payer submission, automated statusing and authorization monitoring.. |
| Authorization Management Services (outsourced authorization management & technology-enabled services) | Custom / Contact sales (no public pricing listed) | Flexible staffing + technology-enabled workflows, broad payer connectivity (350+ payers), automation for identification/submission/statusing. (Contact sales for pricing). |
| Prior Authorization Submission API (Change Healthcare / Privatemarketplace) — Developer sandbox | Sandbox / Free for testing (sandbox access is offered free); Production/pricing: Contact sales / not publicly listed | API (JSON and X12-278) for submitting prior auths; sandbox/free trial available for testing; API noted beta in some docs and production connections require sales/implementation engagement. |
Notes: All three offerings direct prospective customers to contact sales or request a demo for commercial/production pricing. No public per-user, per-transaction, or tiered pricing was published on the official vendor pages surveyed.
Seller details
Optum, Inc. (UnitedHealth Group) — Change Healthcare business
Eden Prairie, Minnesota, USA
1972
Subsidiary
https://www.optum.com/
https://x.com/optum
https://www.linkedin.com/company/optum/
