Surgery Prior Authorizations2019-10-21T10:32:59+00:00

The Challenge

Lack-of-automation-Infinx

Getting the Authorization

You’ve diagnosed a patient and surgery is medically necessary. But now you have to get a prior authorization, which for 90% of doctors disrupts the patient process. It’s complicated, pain-staking process that strains the resources on your clinical staff. Payer guidelines change so often, denials become inevitable, especially overworked staff produce errors in 35% of the cases.

Current solutions are long on promises but short on the ability to fully automate the prior authorization workflow and ultimately require human interaction. The prior authorization process is costly, very complex, and creates scheduling nightmares. Payors are continuing to bring more procedures under prior authorization review, and portals and guidelines regularly change. All of these requests frequently take time away from patient care, which directly affects customer satisfaction and your bottom line.

Automate Your Prior Authorizations

A Scalable Prior Authorization Solution

Infinx Prior Authorization Software evaluates each case to determine which cases can be automated by AI. Exceptions are managed by our trained and certified team of prior authorization experts.

Prior Authorizations Accelerated By Artificial Intelligence

Infinx’s Prior Authorization Software for surgery practices blends automation, integration, cognition, and control to offer you an optimized workflow. It leverages artificial intelligence (AI) to accelerate your processes, including our real-time No Auth Decision Engine, making it easy to discover cases that don’t require waiting for approval. Cases needing more in-depth attention are forwarded to our global team of specialists who can process your prior authorizations with speed and impeccable accuracy.

Infinx’s Prior Authorization Software is built on our comprehensive product platform with built-in critical modules that allow you to expand as you grow. The prior authorization module includes seamless HL7 integration to your EHR, and a vast network of clearinghouse integrations, helping you maximize your collections while minimizing denials.

No Auth
Decision Engine

Determining if a case requires a prior authorization shouldn’t be hard. That’s why we’ve created our No Auth Decision Engine to give you immediate insight if a case needs a prior authorization, before spending the time to call a payer. This process can cut as much as 30% of your workload just by reaching a decision ahead of time.

3.6 No Auth Decision Engine

Exception Handling by Proven Experts

Prior authorizations for surgery practices are complex and inevitably require human intelligence to manage the exceptions. In-house teams often have error rates as high as 35%, which creates a drain on resources and revenue. You can improve your patient access by enhancing and automating your prior authorization process so that you can skip the challenges and see immediate benefits in your workflow, including:

  • Authorization appointments processed well within time
  • Obtaining a high percentage of prior authorizations
  • Low prior authorization denial rates because of complete, accurate, and properly-tracked documentation

Our solutions help you get ahead of the revenue cycle problem by quickly authorizing and confirming every procedure rendered and can be billed with near certainty to its accuracy and propensity to collect. Our experience working with payors nationwide, allows you to receive STAT approvals in as little as 20 minutes and same day appointments within 4 hours, at 100% accuracy and 100% adherence to a 24-hour TAT, allowing you to capture more revenue for your business.

3.21 Exception Handling

Prior Authorization Software Features:

Real-Time Data
You Need Now

Automate your prior authorization. Get the data you need immediately to make good decisions about patient payment and scheduling.

No Auth Required
Decision Engine

Get immediate results to determine whether or not a prior authorization is required for services rendered.

Optimized
Scheduling

With real-time recommendations for no auth requirements and prior authorization ETA, you can schedule your patients with certainty.

Exception
Handling

Cases that cannot be automated are handled by experts who are deeply knowledgeable on payor guidelines and protocols.

Web Portal or
Seamless Integration

We give you options to view information in a web portal view, or seamless HL7 integration with your existing EHR.

Extensive Payer and
Clearing House Integrations

Extensive Payer and Clearing House Integrations for a robust coverage for your insurance eligibility needs.

How We Do It

1

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

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

3

Automated Status Checks

Automated follow-up with payers and real-time status updates provided to help your staff schedule procedures on time.
4

4

System Updated

Once prior authorization is obtained, the authorization approval package is automatically sent back to your system.
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.

Our Results

Prior Authorization
Processed Yearly
1MM
Satisfied
Customers:
100+
Reduce
Denials by:
50%
Accuracy
Rate:
>99%