MHK Introduces SmartProminence: Natively Built AI That Drives Operational Excellence for UM, CAG, and Pharmacy
MHK, part of the Hearst Health network, has launched SmartProminence, a suite of AI features embedded across its platform with an initial focus on Utilization Management (UM), Complaints, Appeals & Grievances (CAG), and Pharmacy Management. The goal is straightforward: streamline intake and case workflows, cut manual effort, and raise compliance readiness while improving outcomes for members.
The company states its AI agents modernize routine steps so staff can concentrate on accuracy, timeliness, and higher-value work. As Maurice Herbelin, MD, MBA, Chief Medical Officer at MHK, put it, "Healthcare organizations are under immense pressure to balance clinical appropriateness, regulatory compliance, and member experience, all with increasingly constrained resources. Our SmartProminence AI solutions enhance the organization's ability to make timely, accurate, and evidence-based decisions."
What Operations Leaders Need to Know
- AI fax intake (available Q1 2026): Automatically captures, classifies, and routes prior authorization requests. Handles complex and multi-request faxes with intelligent triage to reduce manual entry and shorten case resolution times. Available across UM, Pharmacy Management, and CAG.
- Compliance-ready guardrails: Built-in checks aligned with CMS, NCQA, and state requirements to help teams stay audit-ready.
- Actionable insights with CareProminence DataVisor®: Real-time analytics, dynamic dashboards, and advanced reporting to track performance, utilization, and compliance-so you can manage operations with clarity.
- Natively embedded: Capabilities are built into the MHK portfolio, reducing integration friction and keeping workflows in one place.
"Operational excellence is about more than efficiency-it's about delivering consistent, reliable, high-quality outcomes," said Conor Bagnell, President of MHK. "By embedding AI into the MHK portfolio and pairing those insights with CareProminence DataVisor's advanced dashboards, organizations can turn complex processes into streamlined, proactive operations."
Expected Impact on Core Workflows
- Prior authorization intake: Auto-capture, classification, and routing shorten intake-to-decision time. Track reductions in manual entry, faster triage, and higher first-pass accuracy.
- Utilization Management: Consistent, evidence-based recommendations with prepopulated documentation and clear audit trails to support timeliness and quality.
- Complaints, Appeals & Grievances: Intelligent triage by severity and due dates, with routing and response templates that help reduce missed deadlines and rework.
- Pharmacy Management: Streamlined handling of prior auth and refill requests, including benefit validation and formulary checks to cut back-and-forth.
- Compliance readiness: Timestamped actions and policy mapping to CMS/NCQA/state rules reduce risk and prep teams for audits.
Implementation Timeline and Considerations
The AI fax intake capability rolls out to MHK clients in Q1 2026 across UM, Pharmacy Management, and CAG. Plan for integration with your existing MHK modules, fax ingestion setup, and routing rules before go-live.
- Select a pilot line of business and capture baselines: intake cycle time, staff touches per case, auto-classification rate, and timeliness compliance.
- Configure routing logic and compliance guardrails; map CMS/NCQA and state deadlines to queues and alerts.
- Train staff and refresh SOPs to reflect new steps, exceptions, and escalation paths.
- Run a 2-4 week parallel test, then set confidence thresholds for auto-routing and exception handling.
- Review dashboards weekly; tune rules using exception trends and audit feedback.
Keep data governance tight: confirm BAAs, retention schedules, and PHI handling. Ensure access controls and logging meet internal and external audit standards.
Metrics That Matter
- Prior auth intake-to-decision time; percent auto-classified and routed; exception rate; rework rate
- First-pass resolution; overturn rate; documentation completeness
- ICD/CPT data capture accuracy; timeliness compliance by product and state
- Audit findings (type, severity, recurrence) and remediation cycle time
- Member experience: complaint volume, response timeliness, and trend by root cause
Who Benefits
- Health plans and PBMs under staffing and timeliness pressure who need predictable outcomes
- Operations leaders seeking fewer manual steps, stronger compliance posture, and clearer KPIs
- Care teams who want more time with members and less time on repetitive intake and documentation
About MHK
MHK (formerly MedHOK) provides healthcare SaaS solutions for health plans, pharmacy benefit managers, and provider-sponsored organizations. Its platforms support utilization management, case management, population health, pharmacy management, enrollment, and compliance. Headquartered in Tampa, Fla., MHK partners with payers nationwide to optimize operations, improve outcomes, and deliver better member experiences.
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