An influx of new patients should be a great prospect for any provider, but a lack of capacity to accommodate it can lead to backlogs, bottlenecks, frustrated staff, and worst of all, patients leaving to seek other, more efficient providers.
A national diagnostic laboratory with a focus on prenatal genetic screening was poised to ramp up production significantly. The new patients were primarily seeking prenatal and carrier screenings during the ninth week of pregnancy. With the highly sensitive nature of the screenings, the lab would need to focus on patient privacy.
Patient Access Plus Chosen To Support Major Service Expansion
A rapid influx means patient access would be bombarded. The lab wanted to make sure it could accommodate prior authorizations to speed patient scheduling. It needed a vendor that could ramp up quickly. We felt a pilot program would best demonstrate our ability to handle their prior authorization overflow while improving accuracy and reducing denials and turnaround time.
The lab valued our familiarity with insurance companies and prior authorization requirements in regions instrumental to their business. Our deep experience with payers in Texas, Illinois, and Maryland included Tricare East, Medicaid Connecticut, UMR – Sutter Select, and more. We were also able to demonstrate our track record for speed, transparency, and accuracy. After screening several prior authorization solutions, the clinical lab selected us.
The initial prior authorization pilot project consisted of 1,000 jobs to be completed within 30 days. We were able to handle roughly 50 accounts a day with 98 percent accuracy. We were also able to shave off a day on the prior authorization turnaround time – from four days to three.
We were also able to significantly improve the accuracy of predicting when an authorization would be required by a payer. The client was extremely pleased with the results of the pilot program and the positive effect on its denial metrics.
The average accuracy rate for in-house prior authorization teams.
The average accuracy rate of our Prior Authorization Software.
After the pilot project had concluded, we sat down with the client and showed them how we could continue to boost revenue at scale. The lab was highly motivated as they were in the process of transitioning to a bigger organization and wanted to demonstrate the highest possible profitability.
In total, we have successfully addressed 7,130 prior authorizations with over 98 percent accuracy.
On the heels of the successful pilot project, the lab contracted with us to handle more volume. Infinx now handles over 100 prior authorizations per day, which quadrupled the laboratory’s original volume. More, our quality group conducts regular audits to optimize our processes.