Mesh Health Solutions

Mesh Health Solutions is a healthcare information technology company that focuses on automating medical prior authorization (mPA) workflows for health plans, providers, and healthcare vendors. The company addresses the administrative burden of the 600 million annual medical prior authorizations processed in the U.S. by integrating with existing payer systems to streamline data intake, case building, and triage processes.

The platform supports omni-channel intake from multiple sources including fax, electronic health records, EDI, and provider portals. Mesh's technology is built on HL7 FHIR standards and includes a Smart on FHIR app that interfaces with provider EHRs. The company is actively testing the proposed PARDD APIs to align with CMS interoperability and prior authorization requirements set to take effect by 2026-2027.

Led by executives with over 30 years of combined utilization management experience from organizations including Cigna, eviCore, Humana, and Allscripts, Mesh Health Solutions brings clinical, technical, and business expertise to the prior authorization space. In December 2024, the company announced a strategic partnership with KONZA National Network, a Qualified Health Information Network under TEFCA.

Choose Mesh Health Solutions if you're a health plan looking to automate prior authorization workflows without replacing existing systems, particularly if you're preparing for upcoming CMS regulatory requirements around interoperability and processing timelines.

The company's approach of working behind the scenes to connect disparate data sources and automate manual steps makes it suitable for payers who need to improve efficiency while maintaining current infrastructure investments. The KONZA partnership provides access to established health information exchange networks.

Mesh Health Solutions operates exclusively in healthcare, specifically targeting the medical prior authorization segment for health plans and payers. The company's leadership brings experience from major healthcare organizations including Cigna, eviCore, Humana, and Allscripts, with specific expertise in utilization management and prior authorization workflows.

The platform addresses HIPAA compliance requirements and is designed to support the CMS Interoperability and Prior Authorization Final Rule mandating FHIR standards by 2027 and process improvements by 2026. The company's partnership with KONZA National Network, a TEFCA-designated QHIN, demonstrates focus on healthcare-specific data exchange infrastructure.

Health plans and payers of various sizes dealing with high volumes of medical prior authorization requests who are seeking to reduce administrative costs and meet CMS requirements for faster turnaround times. Organizations looking to leverage Health Information Exchange infrastructure and FHIR standards while maintaining existing technology investments.