Utilization management is being forced to modernize on a deadline. The CMS Prior Authorization Final Rule, provider outcry over prior-auth friction, and rising expectations for real-time decisions are pushing payers off legacy UM systems. Taction Software builds custom utilization management software — prior authorization, concurrent and retrospective review, appeals, and the Da Vinci PA APIs — for payers, TPAs, and UM vendors that need to modernize before the rule lands and reduce the friction that providers and members feel.
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Da Vinci PA expertise · FHIR specialist team · payer-tech experience · HIPAA + BAA
Why UM Software Is Being Forced to Modernize
CMS Prior Authorization Final Rule (Effective 2027)
The CMS Interoperability and Prior Authorization Final Rule introduces API and decision-timeframe requirements, with the Prior Authorization API requirement effective in 2027. It is the clearest forcing function UM has seen — see our overview of 21st Century Cures Act compliance.
Provider Abrasion & Outcry
Prior authorization is the single biggest source of provider friction with payers. Modern UM software that reduces that abrasion is now a competitive and regulatory priority.
AI-Enabled UM Capabilities
AI can take work off reviewers and speed clear-cut decisions, which is reshaping what a UM platform is expected to do.
Real-Time Processing Expectations
Providers and members increasingly expect near-real-time decisions, which legacy batch-oriented UM systems cannot deliver.
UM Software Capabilities We Build
Prior Authorization Workflows
Provider submission portals, auto-approval logic for requests that clearly meet criteria, clinical review workflows, and decision support for reviewers — the heart of a modern PA system.
Concurrent & Retrospective Review
Length-of-stay management, medical necessity review, and discharge planning coordination for inpatient and post-acute oversight.
Appeals & Grievances
Multi-level appeals workflows, documentation aggregation, and timely-resolution tracking so appeals are handled correctly and within required timeframes.
Care Management Integration
Case management handoff and high-cost claimant workflows so UM connects to the rest of the plan’s clinical operations.
Da Vinci PA API Implementation
We implement the Da Vinci prior-authorization API suite that the CMS rule and the market are converging on: Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), Prior Authorization Support (PAS), and the provider EHR integration that makes them usable in the clinician’s workflow — built on our FHIR API development and HL7 work.
AI-Enabled UM
AI-Assisted Medical Necessity Review
We build AI that assists reviewers — surfacing relevant clinical information and flagging where criteria are or are not met. Adverse and denial determinations remain with qualified clinical reviewers; AI assists, it does not autonomously deny.
Documentation Summarization for Reviewers
We build documentation summarization so reviewers spend less time hunting through records, drawing on our clinical NLP and payer AI work.
Auto-Approval Logic with AI
We build auto-approval for requests that clearly meet criteria, so straightforward cases clear quickly and reviewers focus on the ones that need judgment.
Integration
We integrate UM with the rest of the payer stack: core administrative system integration, provider EHR integration via FHIR, member portal integration, and care management system integration, so UM is connected rather than siloed.
Engagement Models
We work in four common shapes: a custom UM platform for a payer or TPA, UM SaaS product development, Da Vinci PA compliance engineering, and legacy UM modernization (see our software modernization practice). For the broader payer stack, see our payer software development and value-based care work.
Schedule a UM Software Strategy Workshop →
Frequently Asked Questions
Are you ready for the CMS PA Final Rule 2027?
Yes. We build the prior-authorization APIs and decision workflows the rule requires, including the Da Vinci PA suite and the Prior Authorization API effective in 2027, and help you sequence the work to be ready ahead of the deadline.
Do you implement Da Vinci PA APIs?
Yes. We implement Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS), with provider EHR integration so they work in the clinician’s workflow.
Can you integrate with our existing core admin?
Yes. We integrate UM with your existing core administrative / claims system rather than requiring replacement, building the PA, review, and appeals workflows around the core you already run.
What about AI-enabled medical necessity?
We build AI to assist reviewers — summarizing documentation, surfacing relevant evidence, and auto-approving requests that clearly meet criteria. Denials and adverse determinations stay with qualified clinical reviewers; the AI accelerates the work and supports the decision rather than making it autonomously.
Schedule a UM Software Strategy Workshop →
Reviewed by Taction Software’s payer technology and healthcare integration engineering team. ISO 27001-certified information security management. PHI is handled under a signed BAA — see our HIPAA-compliant development and data security practices.