Top Hospital System Transforms Prior Authorization Process Using Verata Artificial Intelligence

Background

New England Baptist Hospital (NEBH) is part of the 13-hospital Beth Israel Lahey Health System, a nationally ranked provider organization affiliated with Harvard Medical School. Specializing in orthopedic and spine surgeries, NEBH also provides a comprehensive suite of radiology, physical therapy, and pain services.

Challenge

Prior authorizations were done manually and tracked on an antiquated system. This created a heavy burden on staff that had to rely on paper systems. Staff spent hours on the phone with payers and sorted through stacks of paperwork, causing patient telephone abandonment rates to skyrocket to 16%. Management had no visibility into productivity, time to completion, or process bottlenecks. Practice affiliates and surgeons grew frustrated with delays and high prior authorization denials – to the point of diverting imaging orders from NEBH to standalone imaging centers, resulting in lost revenue.

Results with Verata

Eliminating manual processes with the Verata platform transformed NEBH operations in just a few months. Freed from payer calls, NEBH staff are now able to focus their time on patients. Telephone abandonment rates dropped and have remained below 3% since Verata launched. Today, the department receives an imaging order, completes a PA, and schedules a patient within 2.3 days on average, a dramatic reduction from their 11-day average previously. Patients are scheduled faster than ever, and patients and physicians are happier. By streamlining PAs, NEBH has strengthened its financial position as well.

“Verata is one of the best decisions we’ve made.”

– Tom Gheringhelli, Chief Financial Officer of New England Baptist Hospital/Beth Israel Lahey Health

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