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July 14, 2022

3 Reasons to Add Automated Prior Authorization to Your SaaS Solution

by Susan Lawson-Dawson | Prior Authorization

Whether you provide healthcare practice management, revenue cycle management,  EMR or LIMS software, today’s mostly-manual prior authorization process contributes to your customers’ revenue woes. Between the administrative costs and potential treatment delays or abandonment, managing prior authorizations puts the squeeze on their bottom line. 

On top of that, you have disruptive tech players entering the healthcare space on a daily basis. As a result, building a competitive moat turns into a necessity for customer retention, satisfaction and acquisition. 

Need proof? It was Warren Buffet who popularized the concept of competitive moats decades ago. The billionaire investment guru once said, “In business,  I look for economic castles protected by unbreachable moats,” writes stock advisory The Motley Fool.  

What does a competitive moat look like? 

As the playing field for healthcare software vendors gets more crowded and competitive, reinforcing your competitive moat is a must. It’s especially important because one of the most common moats—high switching costs—is about to evaporate. 

Why are high switching costs usually effective? Think about what’s involved with shifting your entire organization to a new cloud provider or CRM software. Change management hassles like transferring accumulated data and driving user adoption can make living with the status quo more appealing. But relying on high switching costs as a moat can backfire because inconvenience and fear, rather than brand loyalty, keep the moat full. 

How does integrating automated prior authorization strengthen your moat? 

High switching costs will decline as interoperability improves (and it will). Citing research from HIMSS Analytics, Healthcare IT reported in 2018 that 75% of hospitals deal with 10 or more EMR vendors across their acute and post-acute care networks. The fact that most of these systems don’t talk to each other—let alone the payers involved—creates disjointed experiences for everyone involved. 

With the Centers for Medicare & Medicaid Services (CMS) moving full steam ahead on interoperability mandates, the high switching costs moat will start to dry up and customer retention challenges will rise.

A survey found that 88% of EHR vendors recognize that demand for electronic prior authorization is growing. What’s more, 86% say that increasingly, customers expect the functionality. Delivering an in-demand solution like automated prior authorization adds depth to your moat, giving your customers a reason to stay and competitors’ customers a reason to move.  

A prior authorization integration helps you get (or stay) ahead

 If you want to beat the competition and expand your market share, give your customers what they’ve been clamoring for: automated prior authorization. 

Manual prior authorization takes up valuable clinical and back-office staff time. What’s more, the burden is increasing. For example, 84% of physicians say the number of prior authorizations required for prescription medications and medical services has increased over the last five years. In addition, 65% say determining whether a prescription medication requires prior authorization is difficult and 62% report the same regarding medical services. 

With Myndshft automated prior authorization integrated in your existing solution, you lighten the burden on customers, eliminating >70% of manual work required for prior authorization.  And because our solution pre-checks prior authorizations before submission, your customers reduce rework resulting from preventable denials. 

1. Avoid the time, expense, and risk of building it yourself  

Why build from scratch, especially for a notoriously complex problem like prior authorization? A white-labeled solution is a more cost-effective, efficient approach. 

For instance, Myndshft offers an automated prior authorization solution that leverages Collective Healthcare Intelligence™, a single source of truth for patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. 

At the heart of the Myndshft platform is a sophisticated policy engine that uses individual payer medical guidelines for each potential CPT code. It also determines the correct preauthorization form and preferred submission method, enabling a seamless workflow. 

Think about it: There are hundreds of payers, all with multiple policies and submission requirements in play. On top of that, there are more than 10,000 CPT codes, with annual changes. This year alone, for example, 249 new codes were added, 63 were removed, and 93 were revised. 

Why do the heavy lifting, when there’s another option? 

Myndshft builds the logic that powers our prior authorization solution by scanning payer websites, identifying prior authorization requirements in specific medical policies, and builds out a library for each payer, plan, and CPT code combination. This results in a ‘Yes’ or ‘No’ requirements determination. If a prior authorization is required, Myndshft provides prompts to ensure appropriate documentation is included and then automatically submits the request as a seamless part of your customers’ existing workflows. 

Our solution keeps pace with change and meets the interoperability and security standards being set by the CMS, the Office of the National Coordinator for Health Information Technology (ONC) and other influencers in the industry. 

2. Accelerate business growth with a new revenue stream

Eighty-eight percent of physicians rate the burden of prior authorization administration as high or extremely high. Imagine how solving this burden strengthens brand loyalty among your customers and overcomes switching inertia of your competitors’ customers. 

Plus, you reap the benefits of a lucrative new revenue stream based on prior authorization transactions. In 2021, providers handled 142 million medical prior authorizations, and the number of services and medications requiring prior authorization continues to climb.  You do the math. That’s money left on the table if you don’t have prior authorization integrated into your solution. 

3. Deliver better user experiences

Adding prior authorization as a seamless part of your customers’ existing workflow gives you an edge. Why? Because it gives your customers an edge. Currently, manual prior authorization is the most costly and time-consuming transaction in healthcare. According to the 2021 CAQH Index, automating prior authorizations could save $437 million annually across the medical industry. It could also save at least 16 minutes per transaction for providers.  

With Myndshft integrated within your software, the entire prior authorization process from requirement identification to submission and monitoring, takes just seconds. Your customers and prospects will get behind those kinds of cost and time savings, deepening your competitive moat with a high-margin transaction.  

Find out why Myndshft is your ideal partner for a prior authorization integration.