Managing Volume and Denials
Ambulatory care teams know the pain of the payment lifecycle. The vast number of cases requiring prior authorization makes the process exceptionally complex, and an administrative burden. It delays patient care and a lack of process leads to denials inevitably affects revenue down the line. 90% of doctors say it directly affects patient care.
Simplifying the process requires automation and knowledgeable experts who can handle changing guidelines and quick deadlines. Ambulatory care teams need a complete payment lifecycle solution that includes a robust prior authorization solution. They need certified experts who can properly code and bill the first time and manage denials promptly.
A Scalable Prior Authorization Solution
Infinx Prior Authorization Software evaluates each case to determine which cases can be automated by AI. Exceptions are managed by our trained and certified team of prior authorization experts.
Prior Authorizations Accelerated By Artificial Intelligence
Infinx’s Prior Authorization Software for ambulatory care teams blends automation, integration, cognition, and control to offer you an optimized workflow. It leverages artificial intelligence (AI) to accelerate your processes, including our real-time No Auth Decision Engine, making it easy to discover cases that don’t require waiting for approval. Cases needing more in-depth attention are forwarded to our global team of specialists who can process your prior authorizations with speed and impeccable accuracy.
Infinx’s Prior Authorization Software is built on our comprehensive product platform with built-in critical modules that allow you to expand as you grow. The prior authorization module includes seamless HL7 integration to your EHR, and a vast network of clearinghouse integrations, helping you maximize your collections while minimizing denials.
Determining if a case requires a prior authorization shouldn’t be hard. That’s why we’ve created our No Auth Decision Engine to give you immediate insight if a case needs a prior authorization, before spending the time to call a payer. This process can cut as much as 30% of your workload just by reaching a decision ahead of time.
Exception Handling by Proven Experts
Prior authorizations for ambulatory care teams are complex and inevitably require human intelligence to manage the exceptions. In-house teams often have error rates as high as 35%, which creates a drain on resources and revenue. You can improve your patient access by enhancing and automating your prior authorization process so that you can skip the challenges and see immediate benefits in your workflow, including:
- Authorization appointments processed well within time
- Obtaining a high percentage of prior authorizations
- Low prior authorization denial rates because of complete, accurate, and properly-tracked documentation
Our solutions help you get ahead of the revenue cycle problem by quickly authorizing and confirming every procedure rendered and can be billed with near certainty to its accuracy and propensity to collect. Our experience working with payors nationwide, allows you to receive STAT approvals in as little as 20 minutes and same day appointments within 4 hours, at 100% accuracy and 100% adherence to a 24-hour TAT, allowing you to capture more revenue for your business.
Prior Authorization Software Features:
You Need Now
Automate your prior authorization. Get the data you need immediately to make good decisions about patient payment and scheduling.
No Auth Required
Get immediate results to determine whether or not a prior authorization is required for services rendered.
With real-time recommendations for no auth requirements and prior authorization ETA, you can schedule your patients with certainty.
Cases that cannot be automated are handled by experts who are deeply knowledgeable on payor guidelines and protocols.
Web Portal or
We give you options to view information in a web portal view, or seamless HL7 integration with your existing EHR.
Extensive Payer and
Clearing House Integrations
Extensive Payer and Clearing House Integrations for a robust coverage for your insurance eligibility needs.
How We Do It
Is Authorization Required?Our software determines if a prior authorization is required or not. If an authorization is not required, you are notified immediately so you can schedule the procedure.
Initiate and Submit RequestIf authorization is required for the procedure, the claim is electronically submitted to the payer. Complex claims and manual submissions are handled by our certified prior authorization specialists.
Automated Status ChecksAutomated follow-up with payers and real-time status updates provided to help your staff schedule procedures on time.
System UpdatedOnce prior authorization is obtained, the authorization approval package is automatically sent back to your system.
Is Authorization Required?
Our software determines if a prior authorization is required or not. If an authorization is not required, you are notified immediately so you can schedule the procedure.
Initiate and Submit Request
If authorization is required for the procedure, the claim is electronically submitted to the payer. Complex claims and manual submissions are handled by our certified prior authorization specialists.
Automated Status Checks
Automated follow-up with payers and real-time status updates provided to help your staff schedule procedures on time.
Once prior authorization is obtained, the authorization approval package is automatically sent back to your system.