Gartner, Inc., the premier research and advisory group covering business and industry throughout all sectors, has recently issued a report that earns Infinx a top finish on the list of advanced automation prior authorization vendors. The report entitled “7 Ways Payer CIOs Can Grow Profits in Medicare Advantage, Managed Medicaid, and Individual Exchange Markets,” by analyst Bryan Cole, reviews the economic fallout from COVID-19 that has severely damaged U.S. healthcare payers’ patient membership.
With millions of people still out of work and the vast majority unable to afford COBRA, the Gartner article examines positioning for success in the future after COVID-19. As patients move towards exchange-traded plans and Medicaid/Medicare alternatives, Mr. Cole’s thesis suggests that payer plans do not move swiftly enough to capture those patients as they redeploy their coverage.
Among several solid business recommendations, Mr. Cole notes that “payers cannot be effective in the long term by using a publicly maligned managed care tactic from days past…prior authorizations play an important role in protecting members from excessive billing or unnecessary care.”
Mr. Cole further states that “Make your prior authorizations effective through automation. Using artificial intelligence (AI) and robotic process automation (RPA) tools, prior authorization automation promises to quickly dispense with incomplete or inaccurate submissions while seamlessly approving routine requests that are low risk”.
Bringing AI Solutions to the Prior Authorizations Question
Utilizing a predefined set of algorithms, Infinx’s AI-driven Prior Authorization Software uses statistical analysis to unlock data insights. It then supports data-driven decisions that improve the timeliness and accuracy of targeted outcomes. AI programming can combine large chunks of data through iterative processing allowing the software to “learn” by memorizing patterns in the data.
To illustrate through the lens of prior authorizations, using automation and AI-driven software would be integrated bi-directionally with a group’s EHR/EMR and billing system being used for client management through cloud-based technology. As a patient’s order arrives, tests or procedures requiring prior authorizations would be electronically identified, provider/facility detail, patient demographics, and test/diagnosis information would be collected, and an approval request submitted in real-time to the insurance payer electronically.
A Comprehensive and Secure Cloud-Based Solution
Infinx creates a seamless and scalable prior authorization solution that uses Health Level 7 (HL7) or Application Program Interface (API) based integration and is compatible with all leading EHR/EMR, Billing, and LIS systems. The Infinx Prior Authorization Software embeds all Patient Health Information (PHI) in layers of security: Electronic Data Interchange (EDI) compliant and stores the data on the cloud using 64-bit and 256-bit encryption that guarantees 100% HIPAA compliance.
An Automated Solution to the Inevitable Prior Authorization Follow-Up, Appeals, and Changes
No longer relying on manual workflow, prior authorizations can be tracked using real-time analytics, followed up electronically 24/7, with the status continually updated on an interactive dashboard. When appeals are needed, customized solutions can be defined, and the system can seamlessly execute its protocols. This eliminates the need for personnel to spend countless hours on hold or faxing information to the myriad insurance payers, each with their own set of guidelines, saving time and reducing claims denials.
Contact Infinx to learn more about our Infinx Prior Authorization Software, using automation and AI, with experienced specialists to provide complete prior authorization coverage.