UM Operations
Straight-Through Processing (Auto-Approval)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
The regulatory boundary: automation can approve, but adverse determinations require appropriate clinical review — you can auto-approve, not auto-deny (beyond administrative rejections). Structured inputs (DTR QuestionnaireResponses, clean 278 data) are what make auto-approval rates move.