CalOptima Aims for Real-Time Payments, Prior Auth Approvals

CalOptima, a Medi-Cal plan in Southern California, launched a five-year blueprint to cut through delays in care approvals and payments, as it seeks to deliver near-immediate claims processing and to put an end to prior authorization-related lags.

On March 21, CalOptima announced a $100 million investment in technology upgrades, which the Medicaid plan seeks to use to reduce barriers to care and to bridge divides — primarily centered on data-sharing — between the plan, providers and community partners.

The payer, which serves nearly 900,000 members in Orange County, also wants to get money into the hands of providers faster, with plans for an innovative “real-time claims processing” system.