Auth Hero provides a cloud‑based case management platform for California workers’ compensation, centralizing medical records, authorizations, and compliance documents. The solution uses FHIR‑based permissions and smart workflows to automate RFA creation, track status in real time, and integrate with EMRs, helping providers reduce manual follow‑up, lower costs, and accelerate claim resolution.
Funding
Funding not disclosed
Founders
Product
Problem
California workers’ compensation claims often involve fragmented workflows, with medical records, RFAs, referrals, and audit trails scattered across faxes, emails, and disparate portals. This disjointed process creates delays, increases manual follow‑up, and raises costs while making it difficult for stakeholders to stay compliant with state regulations.
Solution
Auth Hero offers a cloud‑based case management platform that unifies all claim‑related documents and communications into a single, real‑time workspace. The system leverages FHIR‑based permissions to control stakeholder access and integrates with existing EMR systems to auto‑populate RFAs and referral forms, eliminating manual data entry. Smart workflows track the status of authorization requests from submission through approval, providing instant visibility for claims adjusters, NCMs, and attorneys. Role‑based controls enforce California‑specific compliance mandates, while built‑in audit trails record every action for regulatory reporting. By overlaying on existing technology stacks, Auth Hero eliminates the need for costly system replacements and reduces reliance on fax and email.
Target Audience
Primary users are workers’ compensation claims adjusters, nurse case managers, and attorneys in California who need a compliant, end‑to‑end solution for managing medical records, RFAs, and referrals.
Features
- FHIR‑based permission model that restricts document access to authorized users
- Integrated document repository that replaces fax, email, and portal exchanges
- Automated RFA and referral creation with EMR sync for field auto‑population
- Real‑time status tracking and smart workflow alerts for authorization requests
- Comprehensive audit trail capturing all interactions for compliance reporting
- Unified dashboard delivering a single view of case status, documents, and communication
- Role‑based information flow that enforces California workers’ comp regulations