What is the biggest bottleneck in healthcare delivery? Over the years, prior authorization has earned its reputation as a barrier to care. Despite being intended as a measure to ensure the most effective and cost-efficient treatment, the typical manual prior authorization process often has the opposite effect. A recent Mayo Clinic article, for example, looks at the impact of the prior authorization process on gastroenterologists and patients with inflammatory bowel disease (IBD). Research findings suggest that savings evaporate in the face of care delays that contribute to declining health and subsequently more utilization. One of the study’s co-authors, Dr. Francis… Read entire article here
Dealing with prior authorizations compares to navigating a labyrinth—complex, frustrating, and time-consuming. Created to ensure the optimal use of healthcare resources and minimize unnecessary expenses, these authorizations come in two flavors: medical and pharma. What differentiates the two, and why should you care? As the regulatory landscape around interoperability, prior authorizations, and pharmacy benefit managers (PBMs) continues to evolve, integrated prior authorization software offers a robust solution now and into the future. What distinguishes medical prior auth from pharma prior auth? Medical prior authorizations pertain to the pre-approval necessary for various healthcare services like surgeries, diagnostic tests, or medical equipment.… Read entire article here
Prior authorization for pharmaceuticals is a critical yet often complex and time-consuming process. Healthcare providers and pharmacists face off against a maze of requirements that differ from one pharmacy benefit manager (PBM) or payer to another. This can not only delay patient treatment but also piles on administrative overhead. As a result, choosing the right pharma prior authorization helps you optimize performance to reduce operational expenses while enhancing patient care. Here’s what you need to know. Pharma prior auth more prevalent than ever Specialty medications increasingly capture a larger slice of drug spending in the US. These complex drugs often… Read entire article here
In the ever-evolving realm of healthcare, oncology stands out as a field that requires prompt, precise, and above all, compassionate care. Every procedure, medication, or therapeutic session can be pivotal in a patient's battle against cancer. And herein lies the challenge: How do you ensure that potentially life-altering treatments earn prompt approval, reducing gaps in patients’ care journeys and in your revenue cycle simultaneously? Addressing process inefficiencies with prior authorization automation makes a huge difference. After all, prior authorization doesn’t just result in an approval or denial for patient care. It also confirms a payer’s commitment to reimburse you for… Read entire article here
