In a time of unprecedented transformation in the healthcare industry, staying informed and inspired is not just a benefit — it’s a necessity. That’s why Elligint Health is proud to bring you Sparking Change, our monthly e-newsletter designed especially for our clients and partners. More than just an update, Sparking Change is your strategic companion — offering insights into innovation, performance, and the people driving progress across healthcare.
Get to Know Elligint Health — and the S-P-A-R-K That Guides Us
We don’t just support change, we spark it.
At Elligint Health, our work is powered by purpose—and guided by the core values we live every day. Together, they form the SPARK that drives our team, our mission, and the way we serve clients across the healthcare landscape.
S — Serve
We lead by serving—stepping in, solving problems, and showing up for others. We listen. We help. We make things better.
P — Passion
We care deeply about improving healthcare for everyone. Proactive. Personalized. People-first. Always.
A — Accountable
We act with integrity, own our outcomes, and speak up with bold ideas. We follow through. We drive change. We earn trust.
R — Respect
We treat every person with dignity and value every perspective. Empathy guides us. Performance unites us.
K — Kindle
We ignite energy, curiosity, and momentum — in ourselves and in others. We inspire. We energize. We spark what’s next.
Whether you’re a client, partner, or team member, SPARK is more than an acronym—it’s the heart of how we work and why we care. Thank you for being part of the Elligint Health journey.
Elligint Health Earns High Marks in KLAS 2025 Care Management Report
Clients cite improved service, strong support, and growing confidence in Elligint Health as a strategic care management partner.
Elligint Health has been recognized as a leading partner in providing care management solutions for payers in KLAS Research’s Segment Insights: Care Management Solutions for Payers 2025 report, released on July 30, 2025. We received strong ratings in overall performance and client relationships, including phone and web support and executive involvement. KLAS noted that recent service improvements and enhancements to our Helios® platform have strengthened client confidence.
Customers interviewed for the report praised our growing investment in meeting payer-specific needs and adapting to evolving use cases since our corporate launch in January 2025 and are optimistic about using Helios to support long-term success and improve patient outcomes.
In addition, respondents highlighted our helpful support with data replication, integration with clinical and claims systems, and collaboration on social determinants of health. Clients also reported strong confidence in our security and risk management programs, with no live-environment incidents reported.
KLAS bases its insights on in-depth interviews with healthcare leaders, vendor clients, and other stakeholders, followed by rigorous analysis to ensure accuracy and fairness. Their reports offer trusted guidance to payers and providers evaluating healthcare IT solutions.
Top 3 Utilization Management Features for CMS-0057-F Compliance
Key capabilities that help organizations meet Interoperability and Prior Authorization Final Rule mandates.
As implementation deadlines for CMS’s Interoperability and Prior Authorization Final Rule (CMS-0057-F) approach, healthcare organizations must ensure that their Utilization Management (UM) solutions are ready. This sweeping regulation is designed to streamline the prior authorization (PA) process, increase transparency, and improve experiences for both providers and members.
To support compliance and position your organization for success, make sure your UM platform includes these three essential capabilities:
1. Customizable Workflows and Automated Processing
CMS-0057-F establishes strict timelines for PA decisions — 7 calendar days for standard requests and 72 hours for expedited ones. UM systems that offer configurable workflows and robust automation can help meet these timelines by minimizing manual tasks, reducing errors, and accelerating approvals. These capabilities also improve consistency and free up staff to focus on higher-value work.
2. FHIR-based API Integration
To promote interoperability, the rule requires implementation of a FHIR-based PA API. The API must support secure, auditable, and scalable data exchange between payers and providers. A well-integrated API enables seamless submission, tracking, and communication of PA requests — eliminating silos and reducing back-and-forth delays.
3. Transparent Access and Public Reporting Tools
Beginning March 31, 2026, payers will be required to publicly report PA metrics, including approval and denial rates, average decision times, and more. UM systems must be able to collect, organize, and present these data clearly. Platforms should also provide accessible, up-to-date information on PA policies, decision criteria, and request statuses to promote trust and reduce uncertainty for both providers and patients.
A CMS-0057-Ready Solution: Helios UM®
Elligint Health’s Helios UM is purpose-built to support CMS-0057-F compliance, offering advanced automation, real-time FHIR API integration, comprehensive PA tracking and reporting, and seamless data sharing. In addition, Helios UM supports AI-driven enhancements through our connected ecosystem of partner apps — accelerating decision-making and improving efficiency even more.
In the coming months, Helios UM will debut new tools to further streamline the UM experience. These enhancements will provide greater flexibility, deeper integration, and an even more intuitive interface—allowing healthcare teams to focus on delivering care, not managing systems. Stay tuned for more details on these upcoming features!
To learn how Helios UM can help your organization meet CMS-0057-F requirements, contact your Account Manager today.
New Government-Private Sector Initiative to Build “Patient-Centric Healthcare Ecosystem”
The Trump Administration, in collaboration with CMS, recently announced a significant initiative aimed at transforming the U.S. healthcare system. During a July 30, 2025 event at the White House, major technology and healthcare companies — including Amazon, Apple, Google, and OpenAI — committed to creating a next-generation digital health ecosystem focused on improving patient outcomes, reducing provider burden, and enhancing value.
The initiative centers on two primary objectives aimed at modernizing the healthcare experience to make it “smarter, more secure, and more personalized”:
1. Promoting a CMS Interoperability Framework to facilitate seamless information sharing between patients and providers.
2. Increasing the availability of personalized tools to empower patients in making informed health decisions.
To support these goals, CMS unveiled voluntary criteria for trusted, patient-centered data exchange, accessible to all network types, including health information networks, EHRs, and tech platforms. Over 60 companies have pledged to collaborate in meeting these criteria by the first quarter of 2026. This includes 21 health information networks, 11 health systems or providers, and 7 EHR vendors. The organizations will work together to create CMS-Aligned Networks that adhere to the established interoperability standards.
Additionally, 30 companies have committed to developing tools that leverage secure digital identities to access medical records from CMS-Aligned Networks. These tools aim to enhance patient care by:
• Assisting in the management of chronic conditions such as diabetes and obesity.
• Utilizing conversational AI assistants to help patients check symptoms, navigate care options, and schedule appointments.
• Replacing paper intake forms with seamless digital check-in methods, effectively “killing the clipboard.
This collaborative effort marks a pivotal step toward transforming the U.S. healthcare landscape, delivering better outcomes for patients, and reducing administrative burdens for providers. As these initiatives progress, stakeholders across the healthcare sector are encouraged to engage and contribute to the development of a more connected and patient-centered system.
For more information and updates on this initiative, visit the CMS Newsroom.
For more information about Elligint Health, contact your Account Manager today.