How AI + Automation Optimizes Prior Authorization for Medical Imaging Centers

By Infinx
March 22, 2019

Prior authorization requirements loom large in high complexity diagnostics in imaging centers. From the initial order to the exam, staff must navigate a minefield of potential delays, denials, and redundant, time-consuming manual work to get the authorization approved.

To help your overworked staff members handle the burdensome task of a seemingly endless number of manual insurance verifications and prior authorizations, Infinx’s Prior Authorization Software automates 100 percent of insurance verifications and eligibility and streamlines prior authorization for real-time decision making when scheduling patients.

Medical Imaging Centers Struggle with Prior Authorizations

Over the past two years, imaging centers have seen a massive uptick in prior authorization denials – in some cases as much as 300 percent.

In addition to an increasing number of procedures requiring authorization, imaging centers across the country face issues with meeting clinical requirements due to lack of documentation from referring physicians and constant changes to payer and benefit managed policies and guidelines.

What’s more, the appeals process ties up valuable resources with limited automation Faxing and telephone calls still remain a payer’s primary mode of communication.

Needless to say, these factors cause delays in authorization leading to patient rescheduling and attrition as well as create unwarranted financial risk due to missed prior authorizations and denials. Patients are forced to wait for urgently requested tests – or are even denied – and revenue is lost when tests are conducted, and claims are denied.

For years, imaging administrators have countered the rise in volume by hiring additional staff, but some problems cannot be solved with additional manpower alone. Manual processes like those necessary to determine a prior authorization for a radiology procedure are neither effective nor built to scale. The solution begins with AI. That’s because the greatest value proposition for AI is not the machine’s ability to make critical healthcare decisions, but it’s ability to lift the burden of administrative processes from humans.

A Radiology Network’s Prior Authorization Solution

A national leader in outpatient imaging, which operates more than 340 centers, employs 500 radiologists and thousands of additional employees, sought an effective and transparent solution to their prior authorization woes.

As the largest network in the country, they complete more than 7 million procedures per year or roughly 27,000 procedures per day. If only 20 percent of those exams required authorization, the client’s staff would process 5,400 authorization requests per day.

Infinx’s Prior Authorization Software, which includes the propriety, Authorization Determination Engine, a rules-based engine allows this radiology group to identify authorization requirements in real-time, at the time of scheduling.

In addition, Infinx was able to provide case initiation with all payers, automated follow-up of requests with payers to get real-time approval updates, and transparency into each authorization request and status updates.

The Infinx Prior Authorization Software also provides an unprecedented ability to scale as the radiology centers’ volumes inevitably increase and when the network expands to include additional geographies.

Innovative, Scalable, Transparent – Infinx’s Prior Authorization Software

The AI-powered Authorization Determination Engine in Infinx’s Prior Authorization Software leverages AI to analyze a client’s data and provide deep insight into their prior authorization process, potentially saving medical imaging centers valuable time, resources and money when scheduling procedures.

The cutting-edge machine learning algorithms baked into the software results in an ever-smarter, more efficient product, and also has the capability to be integrated into any EMR or practice management system through an API.

While this engine quickly and accurately identifies authorization requirements based on complex criteria, it is also supported by prior authorization specialists to support manual cases, clinical submissions, peer-to-peer reviews with payers, or interpreting handwritten notes on a report, resulting in a full end-to-end solution to your prior authorization workflow.

Infinx Healthcare provides innovative and scalable patient access and revenue cycle management solutions for not only medical imaging centers, but for various healthcare specialties, providers and hospitals as well. Combining intelligent, cloud-based software driven by artificial intelligence and automation, with exception handling by certified prior authorization and billing specialists, Infinx helps clients preserve and capture more revenue, enabling them to shift focus from burdensome administrative details to billable patient care.

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About the Author

Infinx

Infinx

Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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