Complete Prior Authorization Coverage
Get faster approvals with AI-driven prior authorization technology with exception handling by specialists.
The Challenge
Prior Authorization Approval
Doctors and staff spend way too much time on getting a prior authorization approved. More than 9 in 10 physicians (91%) say that prior authorization programs have a negative impact on patient clinical outcomes. Every week a medical practice completes an average of 31 prior authorization requirements per physician, which takes the equivalent of nearly two business days (14.9 hours). This creates scheduling nightmares and takes time away from patient care.
How Our Prior Authorization Software Can Help
Artificial Intelligence to
Transform Your Prior Authorization Process
Our Prior Authorization Software blends automation, AI, analytics, and human domain expertise to offer a comprehensive solution to the prior authorization process. Our software leverages AI and automation, with exception handling by our certified prior authorization specialists to preserve and increase revenue by streamlining your prior authorization workflow.
Improve your patient scheduling experience with the Authorization Determination Engine, applying machine learning to provide a real-time decision whether a prior authorization is required or not.
Requests requiring a prior authorization are submitted electronically to the appropriate payer, using a unified interface. Complex requests and exceptions are handled by a team of trained specialists to ensure complete coverage of your prior authorization claim.
Status notifications are communicated real-time through automated follow-up.
Prior Authorization Software Features:
Provider
Integration
Submit and update your prior authorization requests directly from your local EHR/EMR using either an API or HL7 based bi-directional integration.
Authorization
Determination Engine
Determine if your request requires a prior authorization using the Authorization Determination Engine, built using machine learning.
Unified
Workflow Experience
Perform all prior authorization related functions on a unified web portal, built to offer you an intuitive and seamless experience.
Automated
Authorization Follow-up
Keep up with the status of an initiated prior authorization claim using automated authorization follow-up.
Analytics
and Reporting
Obtain full transparency into your prior authorization process using detailed and robust analytics and reporting.
Alerts
and Notifications
Receive constant alerts and notifications pertaining your prior authorization claim, which includes all updates and payer communications
How We Do It
1
Is Authorization Required?
Our software determines if a prior authorization is required or not. If an authorization is not required, you are notified immediately so you can schedule the procedure.2
Initiate and Submit Request
If authorization is required for the procedure, the claim is electronically submitted to the payer. Complex claims and manual submissions are handled by our certified prior authorization specialists.3
Automated Status Checks
Automated follow-up with payers and real-time status updates provided to help your staff schedule procedures on time.4
System Updated
Once prior authorization is obtained, the authorization approval package is automatically sent back to your system.Is Authorization Required?
Our software determines if a prior authorization is required or not. If an authorization is not required, you are notified immediately so you can schedule the procedure.
Initiate and Submit Request
If authorization is required for the procedure, the claim is electronically submitted to the payer. Complex claims and manual submissions are handled by our certified prior authorization specialists.
Automated Status Checks
Automated follow-up with payers and real-time status updates provided to help your staff schedule procedures on time.
System Updated
Once prior authorization is obtained, the authorization approval package is automatically sent back to your system.