CASE STUDY

Streamlining Systemwide Prior Authorizations for a Leading Radiology Group

One of our earliest clients rank amongst the country’s largest networks of outpatient radiology centers, with over 250 locations across the United States, offering state-of-the-art facilities for PET/CT, MRI, CT, nuclear medicine, mammography, ultrasound and X-rays. Serving over 750,000 patients annually, they perform over four million diagnostic and imaging exams, in affiliation with prominent HMOs and independent physician groups (IPAs).

The Client Turned To Infinx After Identifying Several Systemic Bottlenecks

  • High fees, with limited bang-for-the-buck, from existing RCM vendor
  • Inconsistent turn-around times and approval rates
  • Disjointed prior authorization processes among locations, lacking a cohesive workflow management system
  • High number of claim denials attributed to data entry errors in prior authorizations
  • Inadequate auditing and quality control

Meeting The Challenges

This radiology group’s large-scale operations were the ideal environment for the Infinx Prior Authorization Software, our comprehensive cloud-based RCM workflow management tool. Featuring an intuitive dashboard portal, the software provided a structured, end-to-end prior authorization solution for their full network by implementing:

  • Automated job creation, work allocation, resource management, and billing functions
  • Effective process tracking with real-time alerts and timely email notifications
  • Algorithm-driven ‘smart queue’ management
  • Full auditing and advanced analytics to further streamline prior authorization processes

Infinx Delivers

Following the system wide deployment of the Infinx Prior Authorization Software, the client has seen quantifiable benchmark improvements in their workflow efficiency:

  • Average TAT of 4 hours or less
  • Overall approval rates regularly above 99%
  • High data entry accuracy rate of 99.5%
  • <15% additional information requests to referring physicians
  • <5% peer-to-peer escalations
  • <5% patient calls for additional information
  • 100% on-time compliance for STAT jobs

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