One of Pennsylvania’s largest hospital systems was seeking an innovative prior authorization solution to reduce costly payer delays and denials– a frustration both patients and physicians frequently express.
The hospital system evaluated several solutions for revamping their systemwide prior authorization operations and settled on Infinx as the strongest choice.
The solution needed to deliver an enhanced prior authorization workflow while providing seamless integration with EPIC, their existing practice management software (PMS). Strong IT security standards were also necessary to protect patient healthcare information (PHI). Our prior authorization software, a cloud-based solution with exception handling by our prior authorization specialists, satisfied these requirements.
HIPAA Compliant Infinx Prior Authorization Software
Initially, we addressed the customer’s concerns about maintaining full HIPAA compliance, in both technical security and handling of patient protected PHI. These standards have been a hallmark of our software and team:
- All PHI stored via our prior authorization software are fully encrypted, per HIPAA guidelines, and stored on Amazon Web Services S3 cloud servers, at secure locations, providing SOC 2 compliance documentation.
- Patient data is never stored longer than necessary, with regular archiving and purging.
- All files are password-protected and access-controlled, as necessary.
- Prior authorization specialists are proficient in HIPAA-compliant standards and protocols, via formal training and periodic reviews.
- New software updates are thoroughly reviewed and tested for airtight data security, while all technical infrastructure and procedures are regularly audited throughout the year.
Successful Two-way HL7 Integration With EPIC
After demonstrating full HIPAA compliance, our next step was configuring our software to interface with the customer’s existing EPIC practice management system via its HL7 interface. The HL7 interface connects health IT systems so that data can go back and forth between systems (bi-directional). Our interface engineering team, experienced in multiple HL7 platforms, configured the system so that information could come and go between Infinx’s portal and the EPIC practice management system.
Our engineers were able to ensure that our prior authorization software could handle all types of incoming messages. We worked with the hospital interface team to define business rules, flags, and relevant data transmission conditions, developing a list of over 100 possible scenarios, each tested during a week-long exercise. This identified a number of ambiguous triggers, which were fine-tuned in advance of a smooth transition.
The engineering team next designed a way to automatically transmit all authorization-related information back to EPIC, reflecting interim statuses and final outcomes during the process of preauthorization. Testing was conducted to ensure data was flowing back to EPIC at all points.
Establishing Payer Contact Protocols
This regional hospital system consisted of a broad span of physician groups and practices. For purposes of operational consistency, they preferred us to represent ourselves as calling on behalf of the provider imaging facility when contacting payers. This presented multiple challenges of how to properly
- initiate prior authorization calls
- provide necessary clinical information
- follow-up and escalate cases to deliver the most expedient processing possible
After extensively researching requirements of benefit managers and payers, our team developed a comprehensive, fully-compliant methodology for universal payer communications. By the formal launch of service, we were fully prepared to successfully process prior authorizations with virtually any payer based in the United States.
Matching Our Resources To The Customer
The larger size and scope of this customer’s radiology operations also required flexibility of our prior authorization resources to successfully meet this new volume of business. Expanding our team required a systematic, sequential onboarding process to ensure every team member was consistently prepared to implement the technological and operation protocols we’d developed for this customer. This resulted in a clean, organized and speedy roll-out with few notable “growing pains.”
Infinx Delivers Successful Results
- Due to our technical and subject matter experience and flexibility, we provided an advanced, technology-led prior authorization solution custom-tailored to the customer’s stringent security and compliance requirements.
- Our company was able to adapt, expand and rapidly bring new teams up-to-speed via a custom-tailored onboarding program.
RESULTS BY THE NUMBERS
- Overall >95% successful prior authorization approval rate
- 100% SLA compliance to TATs on stat, same day and standard appointments
- 99% error-free audits on all documentation
- 100% compliance to all payer guidelines, protocols
Hospital leaders have been thrilled with these improvements. They regularly share how convenient and simple our solutions are to use.
Have you implemented smart technology like artificial intelligence and automation in your patient access workflow yet? See how a Pennsylvania hospital successfully integrated our AI-powered Prior Authorization solution with their EPIC system.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Have you implemented smart technology like artificial intelligence and automation in your patient access workflow yet? Find out how a Pennsylvania hospital successfully integrated our AI-powered Prior Authorization solution with their EPIC system. Within weeks, they achieved a a 95% successful approval rate and 99% error-free audits on all documentation.