Navigating our healthcare landscape often feels like wading through a sea of administrative hurdles—with prior authorizations recognized as one of the most frustrating. For ancillary service providers like diagnostic labs, it can feel like the prior authorization bar is set even higher. 

Our newly announced collaboration with Shadowbox bridges crucial gaps. Together, Shadowbox instant healthcare automation enables fast integration of Myndshft prior authorization software and facilitates data sharing across different web applications and data silos. This streamlines the prior authorization process within established workflows you  rely on. Our combined solution signifies an evolution in process efficiency but also addresses the unique challenges faced by labs and other ancillary service providers that share a similar position within the healthcare continuum. 

Easing the Weight of Manual Prior Authorizations 

When it comes to prior authorizations, ancillary service providers find themselves in an awkward position. The root of this challenge lies in the distinction between the “ordering provider” and the “performing provider.”

Indirect Patient Interaction

Unlike physicians or clinicians who interact directly with patients, diagnostic labs perform tests based on orders. This distance from the initial consultation means labs often lack immediate access to comprehensive patient data, the test’s rationale, and other details vital for a prior authorization request. 

Reliance on Ordering Providers

Ancillary service providers, not being the ordering entities, often wait for physicians or clinicians to supply the necessary details for prior authorization. Such dependency can cause delays, especially if the provider doesn’t supply the needed information promptly or provides inconsistent data. And those delays can have devastating consequences for your patients.  

Multi-step Communication

“Stuck in the middle again” could be a theme song for ancillary service providers. Diagnostic labs, infusion centers, durable medical equipment providers and others must constantly juggle communications between ordering providers and payers. This back-and-forth not only stretches out the process but may also introduce errors, adding another layer of complexity to prior authorizations.

Volume of Requests

Ancillary service providers serve multiple clinicians, hospitals, and care providers. As a result, your staff must  juggle a high volume of prior authorization submissions, while also delivering ordered services on a daily basis. Managing prior authorizations for this high volume, especially when not the ordering provider, exponentially increases your administrative workload.

Financial Implications

When you conduct a test or another service without securing the prior authorization—whether due to urgency or an oversight—a denial after the fact means no payment. Even if you dispute the denial successfully, payment delays disrupt your revenue cycle. Plus, given the distance from patients’ initial consultations with ordering providers, contesting such denials becomes even more challenging, posing a significant financial threat.

At its core, the distinction between who orders a test (the ordering provider) and who conducts it (the ancillary provider) creates inherent complexities. These challenges underscore the importance of streamlined communication and integrated systems to alleviate the burden of prior authorizations on diagnostic labs.

Learn more about this exciting collaboration.