Prior Authorization Is Still A Pain
In a recent survey, AMA reported a staggering 86% of providers felt that the mechanics of administering prior authorization processing is a burden, 91% felt that it caused patient care delays and 82% reported that the number of prior authorizations required for medical services increased over the last 5 years.
While the healthcare industry is working towards implementing standard electronic prior authorization processing guidelines, it is no secret that in the foreseeable future, providers will still find the process of obtaining prior auth approvals burdensome causing patient care frustrations, delays and abandonment.
Prior Authorizations Accelerated by AI and Automation
Our cloud-based, AI-powered prior authorization software provides a complete patient access solution for healthcare providers by leveraging the latest machine learning, artificial intelligence and automation technology with exception handling by our experienced billing specialists.
Requests requiring a prior authorization are initiated electronically to the appropriate payer. Complex requests and exceptions are handled by our team of certified specialists to provide you with complete coverage of your prior authorization claim.
Status notifications are communicated in real-time through automated follow-ups by robotic process automation (RPA). Our RPA bots repeatedly check requests under review for status change updates.
We provide you with complete coverage of your prior authorization requests with a 98+% accuracy and 99.5% adherence to turnaround times. No more auth requests getting kicked back to you due to lack of information. We take care of it for you.
Key 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 Prior Authorization Required?
Our AI 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 specialists.3
RPA Automated Status Checks
Automated follow-up with payers and real-time status updates provided by our RPA bots 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 Prior Authorization Required?
Our AI 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 specialists.
RPA Automated Status Checks
Automated follow-up with payers and real-time status updates provided by our RPA bots 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.
