What this page covers

  1. CoverMyMeds
  2. Availity
  3. Surescripts
  4. Waystar
  5. Change Healthcare / Optum
  6. Experian Health
  7. Inovalon
  8. TriZetto
  9. eviCore
  10. NIA / Evolent
  11. Carelon
  12. AIM Specialty Health
  13. HealthHelp
  14. How Flexbone navigates all of it

PA runs through a fragmented infrastructure layer: pharmacy clearinghouses (CoverMyMeds, Surescripts), medical clearinghouses (Availity, Waystar, Change Healthcare/Optum, Experian Health, Inovalon, TriZetto), and utilization-management vendors (eviCore, NIA/Evolent, Carelon, AIM, HealthHelp). Each has its own portal, API surface, and quirks. Flexbone operates all of them from one platform.

Clearinghouses and pharmacy networks

CoverMyMeds

CoverMyMeds (McKesson) is the dominant pharmacy PA platform, serving most PBM and payer relationships for medication PA. Providers submit ePA through CoverMyMeds and it routes to the correct PBM. Flexbone submits medication PA through CoverMyMeds via the provider portal or integrated API, handling both electronic ePA (NCPDP SCRIPT standard) and manual submission when the payer requires manual review.

Availity

Availity is the largest healthcare clearinghouse for medical PA and eligibility, serving Anthem, Aetna, Humana, several BCBS plans, Florida Blue, and dozens of regional payers. Availity provides a unified portal for eligibility, PA submission, and claim status. Flexbone operates Availity via API and via browser agent for portal-only workflows.

Surescripts

Surescripts is the dominant prescription routing network and operates e-prescribing, medication history, and electronic PA (NCPDP SCRIPT). For PA specifically, Surescripts provides the ePA pathway for most pharmacy benefit PAs, complementing CoverMyMeds in the ecosystem.

Waystar

Waystar is a large RCM and clearinghouse platform covering eligibility, PA, claims, and payments. Flexbone integrates on the PA submission and status side.

Change Healthcare / Optum

Change Healthcare (now part of Optum) is one of the largest US clearinghouses. After the 2024 cybersecurity incident, the platform has continued operations under Optum. Flexbone uses Change for eligibility, PA where applicable, and claim submission.

Experian Health

Experian Health (formerly Passport) covers eligibility, PA, and claim management. Flexbone integrates on the PA side.

Inovalon

Inovalon ONE Platform includes risk adjustment, quality, and eligibility/PA tools used by many plans and RCM organizations.

TriZetto (Cognizant)

TriZetto (part of Cognizant) is a major payer-platform vendor whose provider-facing tools include PA submission for several payers.

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Utilization management vendors

eviCore

eviCore (owned by Cigna) is the largest US UM vendor. Handles radiology, cardiology, musculoskeletal, oncology, post-acute, specialty drug, sleep, and radiation therapy PA for a wide payer mix: most Aetna, Cigna, Humana MA, and several BCBS plans. Flexbone operates eviCore via XML/API for high-volume providers and browser agent for portal submissions. Separate portal sections for each service line.

NIA / Evolent

NIA (now part of Evolent) handles radiology PA for portions of UHC and several BCBS and Managed Medicaid plans. RadMD portal for provider submission. AUC scoring is required on many submissions under ACR Appropriateness Criteria.

Carelon

Carelon (Anthem/Elevance) is the UM arm covering radiology, cardiology, musculoskeletal, behavioral, and post-acute for Anthem BCBS plans, Highmark, and several Elevance subsidiaries. Formerly branded as AIM Specialty Health. Portal at providerportal.com.

AIM Specialty Health

AIM Specialty Health remains an active brand under Carelon for legacy contracts. Same back-end infrastructure; provider-facing materials may show either name.

HealthHelp

HealthHelp serves radiology, cardiology, and oncology PA for select Humana and Medicare Advantage contracts.

Payer-direct portals

Beyond the clearinghouses and UM vendors, most national payers operate direct portals for PA: UnitedHealthcare Provider Portal (uhcprovider.com), Aetna Health (Availity for many transactions), Cigna HealthCare, Humana Provider Portal, and dozens of regional payer portals. Flexbone operates them all with a mix of API and browser-agent approaches.

Talk to our teamAbout pa portals and um vendors prior authorization workflows and a scoped Flexbone rollout.See the PA platformHow Flexbone automates PA end to end across payer portals, phone, and EHR.

How Flexbone navigates all of it

A single PA from an ordering provider may touch three or four infrastructure layers: EHR -> clearinghouse (Availity) -> UM vendor (eviCore) -> payer portal for status check. Flexbone handles the routing logic automatically based on payer, service line, and procedure. Electronic submission (X12 278, HL7 Da Vinci PAS, NCPDP SCRIPT ePA) is used where the payer supports it. Portal automation is used where not. Voice is used for phone-only lines and peer-to-peer. See the platform.

Infrastructure fragmentation is the hidden cost. Staff spend most of their PA time moving between portals, logging in with different credentials, and learning each system\u2019s quirks. A single browser-agent layer across all 12 infrastructure systems removes that tax and lets staff focus on the clinical exception cases.