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Myndshft Blog

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November 21, 2022

Talking Turkey: How Prior Authorization Software Satisfies Everyone at the Table

by Susan Lawson-Dawson | Prior Authorization

Traditions reign supreme this week. Sharing Thanksgiving dinner with family and friends. Shopping your way through Black Friday, Small Business Saturday, and Cyber Monday. Volunteering and donating on Giving Tuesday. But in healthcare, there’s a tradition in desperate need of an update: manual prior authorization. No need to go through the laundry list of prior auth problems. After all, you experience them every day. Instead, let’s look at how prior authorization software automates the process and how it benefits providers, payers, and patients alike.

Prior Auth Software Handles the Heavy Lifting

Compare the typical prior authorization process with an automated one. 

Manual Prior Authorization
Automated Prior Authorization 
Search payer documentation or call payer directly to determine if prior auth is required and submission criteria based on an individual patient’s verified benefits and eligibility.

Estimated time to complete: 28 minutes (and that’s not including potential hold time.)

Enter minimal data and prior authorization software takes over, reducing repetitive data entry (and potential typos) and quickly determining if prior authorization is required. 

Estimated time to complete: Under a minute because transactions run simultaneously.

Gather the necessary information and enter it (AGAIN) in the appropriate form. Track down any other required documentation and attach with the submission. Fax or upload to the payer portal (if available).

Estimated time to complete: 20 minutes

If prior authorization is required, the software automatically gathers the needed information, pre-checks it for errors or omissions, and submits the request using the payer’s preferred submission method. 

Estimated time to complete: Under 5 minutes

All of this is possible because of several critical pieces of the prior authorization puzzle. Starting with access to what we call Collective Healthcare Intelligence™. It creates a  single source of truth for patients’ health and benefits information, providers’ clinical documentation, and a payers’ plans and policies. 

Using secure HL7FHIR APIs to enable seamless data exchanges, intelligent automation makes short work of identifying prior authorization requirements and preparing submissions that are right the first time, reducing care delays and the rework associated preventable denials. 

Who Reaps Benefits with Prior Authorization Software?

In addition to significant time savings, automated prior authorization delivers other benefits. Who wins? Everyone. 

Benefits for Providers

With Collective Healthcare Intelligence and automation, providers no longer have to rely on institutional knowledge or detective work to determine if prior authorization is needed and what information needs to be submitted for a quick approval. 

Not only does this make onboarding new hires easier, but it also allows you to reallocate staff to more challenging and rewarding work, increasing staff satisfaction.  It reduces manual work by at least 70% and can  eliminate up to 90% of rework thanks to submitting cleaner requests.  

Benefits for Payers

From the payer perspective, prior authorization software enables rapid decisions. With a centralized platform for incoming prior authorization requests, you can quickly see if submissions meet the criteria. 

You can also set up custom auto-adjudication so that your staff can focus on more complex requests. And a clinical decision support engine can provide added confidence when making decisions. A convenient reporting dashboard can offer further insights. Prior authorization softwares helps payers do what’s best for their members. It ensures members get needed care sooner, which can shorten episodes of care giving both member satisfaction and your bottom line a boost.  

Benefits for Healthcare SaaS Vendors

If your domain of expertise isn’t prior authorization, building a solution to solve today’s problems won’t be easy. Prior authorization software that integrates directly with your EHR or other system of record allows you to go to market quickly to get a leg up on your competition. 

And since prior authorization is a problem that providers want solved yesterday, delivering a solution can help you retain and grow your customer base. 

Benefits for Patients

Ultimately, it’s all about the patients. By automating the prior authorization process, patients avoid delays in care. Such delays aren’t just frustrating. According to the AMA, 34% of physicians say they’ve had patients experience serious adverse events due to the wait time for prior authorization. 

Solving the problems with prior authorization is something everyone at the table can be thankful for. Are you ready to get started?