The client is an East Coast medical imaging center with one of the most successful outpatient radiology practices in the United States. It is also one of the largest single-center imaging centers with three MRIs in one location. They specialize in providing full major modality scans, specifically CT, PET, MRI, and Nuclear Medicine.
The Radiology Group Was Experiencing an Overwhelming Volume of Prior Authorization Demands
Roughly 70% of the referring providers, the group worked with had asked the radiology group to obtain the necessary prior authorizations from the payers directly. The problem was that certain payers were only allowing imaging centers to start the authorization process, but not complete it—other payers don’t allow imaging centers to process the prior authorizations at all. Unfortunately, the client was watching as their competitors sidestepped these rules and continued to process the authorizations themselves. Thousands of dollars per week in patient revenue were at risk. The imaging center needed a way to follow the rules while also remaining competitive.
Additionally, about 30% of the client’s daily patients needed expedited authorizations. Acquiring the necessary approvals from the insurance companies via phone could take up to an hour per authorization—a logistical nightmare for the small authorizations team in place. The client could not counter the rise in volume by simply hiring additional staff. If they wanted to retain patients and also maintain good working relationships with the referring physicians, they needed a solution that could receive authorizations quickly and accurately.
A Prior Authorization Solution that is Ready to Scale
Faced with a high-volume of prior authorizations and a small staff, the imaging group prioritized a solution that could offer total automation of the prior authorization workflow, an interface that was easy for their staff to learn, and cloud-based access so that it could be accessed by any computer. They also needed a legitimate way—payer approved— to process authorizations, and the Infinix solution was the answer.
The proprietary Prior Authorization Software for imaging centers evaluated each of their procedures to determine if a prior authorization was required. The software then initiated the cases electronically that did require an authorization to the specific payer or benefits manager. Once a case was initiated, the software provided the radiology group with an authorization reference number and
continuously followed up with payers by using automation that provided real-time updates and notifications.
The solution was completely integrated with the client’s RIS system. This allowed the provider to work within their system and not have to log into another webbased system to submit their prior authorization requests. This created a low maintenance and low touch experience for the customer and also saved the provider staff a lot of time and effort in manually entering case information into a web portal.
At full utilization, the Infinx Prior Authorization Software provides an unprecedented ability to scale as authorization volumes increase and when a network expands to include new geographies.
In addition, Infinx’s prior authorization specialists were available to manually handle any request, in the event of a complex scenario or if the payer did not support electronic submissions.
Infinx’s Prior Authorization Solution Levels the Playing Field Within 2 Months
It only took four weeks to go live and two months to see results, which leveled the playing field with their competition. By utilizing Infinx’s Prior Authorization Software, the radiology group has realized a number of tangible benefits:
- Reduced insurance verification and benefits processing time
- Eliminated the need for another full-time employee to process the authorizations
- Faster turnaround times for patient authorizations and scheduling
- Significantly reduced manual and burdensome administrative tasks
- Strengthened relationships with referring physicians and medical practices
While today Infinx processes 200+ imaging scans per month for this radiology group, within a year’s time they anticipate that number of prior authorizations increasing significantly to as many as 800 to 1,000 imaging scans per month.
The group is now poised and excited to deploy the full utilization of Infinx’s Prior Authorization Software, which includes the proprietary Authorization Determination Engine—a rules-based engine that leverages machine learning to authorize requirements in real-time and optimizes the radiology group’s workflow and patient retention efforts. With full utilization of the Prior Authorization Software, the group believes it will be able to handle the increased volume efficiently and effectively.