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Myndshft Blog

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January 30, 2023

Must-Read Advice Before You Select a Prior Authorization Software Partner

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Charles Darwin, father of the theory of evolution, wrote, “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” While he may have been talking about flora and fauna, Darwin’s theory seems quite relevant to Software as a Service (SaaS) providers in today’s rapidly-evolving healthcare landscape. Integrating prior authorization software in your existing solution can transform it. How? 

Adding prior authorization automation can make your platform “stickier” with your current customers. In addition, it can make you more attractive to prospective customers who are increasingly frustrated by burdensome prior authorization processes. That’s why leading SaaS companies make strong commitments to tech partnerships. Choosing the right integrations can enhance your products, adding value for your users that benefits your bottom line. 

Why consider a tech partner for automated prior authorization? 

A majority of healthcare providers still rely on an inefficient, manual process that calls for repetitive data entry and time-consuming phone calls and faxes. You desperately need a better solution. 

But developing a solution in-house—especially one outside your area of expertise—can turn into a costly, time-intensive undertaking. With more than 1000 private or public health insurers (payers) in the US, keeping track of changing prior authorization requirements takes an enormous effort. Each payer has numerous plans and policies that change regularly, which adds up to 2.5 million prior authorization rules and requirements. 

For a solution as complex as automating prior authorization, the build cost can quickly escalate. Not to mention, you also need to account for ongoing maintenance. In the case of prior authorization, as we mentioned earlier, the requirements constantly evolve, which means you must have dedicated resources to maintain up-to-date data. Plus, you have a finite number of resources. Wouldn’t it be better to quickly deploy with relatively fixed costs and timelines?  That way, you can keep your own resources allocated where they add the most value. 

What to look for in a prior authorization software solution 

Our “Build or Buy” eBook takes a closer look at the complexity, cost, control and compliance considerations. But if you have settled on an integration path, then here are three additional areas you should consider: 

Pre- and Post-Implementation Support

Does the partner you have in mind offer robust support before, during, and after integration? While your IT resources avoid building the solution from scratch, they still have involvement in the integration, since they know your platform best. You want to work with a responsive partner who facilitates and supports integration. 

Establish who owns the process, exceptions where other involvement may be needed, where to go for help, and what communication channels to use. You also need to be confident that new releases, feature enhancements, scheduled downtime and other pertinent information gets communicated regularly so everyone stays on the same page as the solution evolves. 

Onboarding Support

Does your future partner have ready-made resources to support onboarding success? As the prior authorization software expert, your integration partner should already have its own customer onboarding and training materials. You may need to customize the resources to fit your brand if using a white-label solution, but you shouldn’t have to start from scratch.   

Go-to-Market Terms

What co-marketing and co-sales opportunities does your partner bring to the table? Your partner’s expertise makes them a valuable contributor to your own sales success. From training your sales staff to providing collateral for customization, your integration partner can help you hit the ground running. 

Ready to add a new revenue stream to your SaaS solution? Request a Myndshft demo to see what integrating prior authorization software could do for your customers.