How do we determine if a prior authorization is required or not?
As payers change their policies, our machine learning algorithms can learn and adapt to these changes. Our software determines if a prior authorization is required at the time of scheduling of the procedure, allowing providers to schedule these patients at the earliest, increasing your revenue and improving the overall patient experience.
Our solution can also help identify if the prior authorization request requires a clinical review and also accurately predicts the turnaround time for that specific case to allow clients the best possible schedule for their patients.
If it is determined that a given procedure requires a prior authorization, the provider can electronically submit the request to all payers, using a single web portal or via an HL7 or API based bi-directional integration with your local EMR/EHR/PMS/RIS/LIS system. This reduces the need to make multiple calls or send faxes to different insurance companies.
Prior authorization requests are electronically transmitted, with exception handling by our certified prior authorization specialists who can handle the manual submissions in complex scenarios or if the payer does not support electronic submissions.