Solve for 100% Volume on Prior Authorizations

By Infinx
December 14, 2018
03:09 pm

While the industry strives for greater efficiency, the prior authorization of procedures can never be totally automated because most require human intervention. Despite this, many of our competitors in the Patient Access space insist on saying their solution is 100 percent automated. In truth, our competitors hover in the 30 percent automation range. What’s more, they don’t have a Human Intelligence (HI) solution for the remaining prior authorizations, which results in constant delays and denials.

A Hybrid Prior Authorization Platform

Infinx’s prior authorization solution is a hybrid platform that leverages automation, HI and Artificial Intelligence (AI). It is also 100 percent successful. Our solution really is a solution. Infinx automates more than any competitor in the space. Those prior authorizations for procedures that cannot be fully automated for processing, are sent immediately to a team of prior authorization specialists.

Meanwhile, our proprietary AI algorithm collects and analyzes this data, improving its own accuracy and efficiency with every interaction. With complete transparency. From the moment it is deployed, it is learning how your Patient Access team – from your directors to your managers to your specialists – work. Infinx provide you with precisely the metrics you need to optimize your prior authorization process.

You Still Need Humans

While AI can crunch vast amounts of data and build patterns from this data, it cannot infer solutions from those patterns – or, as it turns out – read bad handwriting. You still need humans for that. In other words, there is no way to automate the process because it is not standardized.

In fact, the great barrier to a fully automated prior authorization process is the clinical case report; specifically, the doctor’s handwritten notes on the report explaining why the test, procedure or prescription should be authorized. This key document is the bane of automation because no one doctor writes it the same way. It remains such a human document that only humans can decipher it.

And to decipher it quickly and accurately, you need a team of experienced, talented humans. Our expert processors not only understand the guidelines, but constantly updates their qualifications by studying quarterly changes to those guidelines. They can process these exceptions faster than the competition because they know the clinical documentation and process better than the doctors themselves.

Why Places and People Matter in Prior Authorization

We not only speak the language, we also speak the dialect. Prior authorization requests are frequently based on proprietary and nonstandard workflows, which differ from payer to payer and even from state to state. Chances are, Infinx possesses a comprehensive knowledge of the provider’s core payer market in its primary geographic area.

We also understand your people. Prior authorization denials are frustrating at every level of the organization. Handing prior authorizations off to Infinx has a measurably positive effect on your organization’s culture. Don’t let time-consuming administrative processes drain the life out of your talent. Let them focus on the job they’re trained to do, not the job we’re trained to do.

How Can We Help Today?

Today, Infinx works with 60 companies – the largest such network in the country. See how we helped a leading hospital system preserve their revenue by guaranteeing that prior authorization would be obtained before appointments occur. Each of those companies benefits from our collective intelligence – automated and human. Unlike our competitors, Infinx solves for 100 percent volume and is constantly improving its process via a combination of automation, HI and AI.

Make the switch to Infinx and avoid costly prior authorization denials, hours of idle machine time and frustrated personnel. Request a demo today to learn how at sales@infinx.com.

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.

Leave A Comment