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July 24, 2023

Maximizing Efficiency and Minimizing Errors with Prior Authorization Software

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Is your prior authorization process due for an upgrade? Time and again, we’ve seen surveys and analyses that highlight rampant inefficiencies in today’s primarily manual process. The lack of interoperability contributes. So do inconsistent standards for prior authorization across payers. As a result, providers—and the patients they serve—get bogged down in administrative paperwork that contributes to treatment delays or worse. 

In fact, reports Fierce Healthcare, 91% of physicians say that prior authorizations have a negative impact on patient clinical outcomes. Legislation and regulations to address prior authorization are on the horizon, but let’s face it—enacting and enforcing those rules will move at a snail’s pace when you need results now. That’s where automated prior authorization software can help. 

An automated prior authorization workflow benefits providers and patients alike

An accurate, efficient process powered by prior authorization software enables you to provide high-quality care while optimizing operational expenses. What benefits can you expect from implementing prior authorization software? 

Here’s a quick breakdown. 

Improved interoperability

Getting the information needed—from determining if a procedure, treatment or medication requires prior authorization to the clinical documentation—takes much more effort when the information needed remains siloed. Prior authorization software like Myndshft uses intelligent automation combined with Collective Healthcare Intelligence™ to enable seamless access to patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. 

Because of this, you escape the scavenger hunt across the EHR and payer portals to gather prior auth submission necessities. That’s a time saver AND an error reducer, since the software automatically pulls the data needed, eliminating repetitive data entry. 

Real-time eligibility verification

The first step in determining if prior authorization is required rests with identifying the patient’s insurance plans and policies. Prior authorization software simplifies the process of eligibility verification. Myndshft, for example, verifies real-time medical benefits for 94% of U.S. covered patients, thanks to our extensive payer policy library and rules engine. What’s more, the software can instantly access accurate co-insurance, copay, deductibles and other plan details that are critical for point-of-service patient financial responsibility calculations. (And that’s something that your patients definitely want!) 

By checking eligibility in real-time, providers can avoid unnecessary delays or denials and ensure timely patient care. This not only improves operational efficiency but also minimizes errors that may occur due to incorrect eligibility information, leading to potential cost savings and improved patient satisfaction.

Error reduction

Manual handling of prior authorization requests can result in errors due to data entry mistakes or misinterpretation of complex guidelines. Prior authorization software helps minimize errors by automating the process and adhering to predefined rules and guidelines. It ensures that all necessary information is captured accurately, reducing the likelihood of preventable errors that could lead to denials or delays. 

By adhering to compliance standards and reducing errors, healthcare providers can avoid costly resubmissions, rework, and potential penalties. In turn, this results in substantial cost savings while ensuring patients get the quality care they need. 

Enhanced communication and collaboration

Communication and collaboration gain even greater importance as we move toward more value-based care. After all, if all stakeholders remain in the dark about different parts of a patient’s care journey, how can they efficiently coordinate care that truly serves the patient. Prior authorization software facilitates seamless communication. This empowers everyone. Capturing a more complete view enables both providers and payers to ensure their patients/members receive appropriate care, while proactively managing utilization to reduce waste.T

Moreover, better communication minimizes delays, reduces administrative back-and-forth, and ensures accurate information exchange, ultimately optimizing efficiency and reducing operational expenses.

Despite on-going reform efforts, providers report that the number of prior authorizations required continues to grow. The traditional prior authorization process certainly deserves its reputation as labor-intensive and error-prone. As then AMA Chair Jack Resneck, Jr., M.D., noted in 2019,  “The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care.”  

While making the shift to prior authorization software won’t reduce the number of prior authorizations you need to do, it will certainly relieve the burden.  Implementing prior authorization software is a strategic step for providers looking to maximize efficiency, reduce operational expenses, and minimize errors in the process so that patients can get the care they need, sooner rather than later. 

What are you waiting for? Connect with Myndshft to get started.