Three Prior Authorization Processes You Should Automate Now
November 11, 2020
AI-Powered Prior Authorization Solution Obsoletes the Fax Machine, Leads to Faster, Better Care
COVID-19 has had a crushing effect on the U.S. health care system. With no end to the pandemic in sight, health care leaders face mounting pressure to reduce costs to mitigate losses.
Add to that the increased workload furloughs have placed on staff, and human error can escalate exponentially. Despite best efforts, the process of obtaining prior authorization is complex and time-consuming, and errors in prior authorizations result in costly write-offs.
One way to reduce costs and ease the strain on staff is to automate prior authorization.
For a large hospital or health system, the process can demand hundreds of dedicated employees or major outsourcing expenditures. Prior authorization automation increases the number of authorizations completed per hour with far less staff, while ensuring accuracy throughout the entire process.
Many companies have tried to automate bits and pieces of the process, but only Verata Health offers a complete end-to-end solution that’s revolutionizing the system.
Here are three areas where AI prior authorization solutions can radically change your organization’s prior authorization process:
1. Seamlessly initiate prior auths from your EMR
Until recently, prior authorization specialists were forced to manually retrieve clinical notes and documentation from electronic medical records (EMR). If the relevant documents were not available, the case was escalated to the nurse, physician, or physician extender, who then provided the required documentation.
If hospitals want to reduce waste and contain costs, they need to address these kinds of operational inefficiencies. Automation is key.
While many companies have attempted to address the issue, not all solutions are equal. When evaluating technology vendors, be sure to ask how they handle clinical documentation. Verata is one of the few solutions that fully integrate with your EMR.
AI automation pulls the necessary medical history and patient information from your EMR, gives the prior authorization team member the correct paperwork, auto populates the required patient information, and helps submit the prior authorization to the payer, who receives an organized set of information meeting all of the requirements.
Automation pulls everything together that’s needed for prior authorization approval — saving administrative time and getting patients care when they need it.
2. Effortlessly review payer rules and requirements
Under the old way, providers manually comb through payer forms and rules on payer websites, which they have to constantly monitor for changes. If the medical treatment is routine, many prior authorization specialists refer to a cheat sheet they created to remind them of a payer’s rules and point them to the correct forms to complete.
This method is time-consuming and prone to human error. Staff often misinterpret rules and provide incomplete information to payers, which can lead to denials and expensive write-offs.
No longer do teams need to hunt for paperwork and payer rules. Verata keeps track of them so you don’t have to. Verata’s AI software continuously scans the rules of tens of thousands of health plans, then gathers the necessary information from the patient’s medical records within the EMR.
3. Submit and track every authorization to completion
While some health systems turn to robotic process automation (RPA) to handle status checks, RPA has its limitations. Bots require custom builds and maintenance, often leading to downtime whenever your EMR UI changes or a website is updated. If a task fails, a human must intervene. This means that RPA has been limited to only simple, repetitive tasks, and even then, require significant maintenance. .
Verata Health offers a full end-to-end prior authorization solution that is able to help users submit and track every authorization to complete. The platform automatically performs status checks for insurance portals and alerts you when an authorization is approved so your staff is free to focus on patient care.
Faster, better care
Automating the prior auth process is crucial because operational deficiencies can cost you more than just overhead—it can cost you revenue and patient leakage.
Unlike other software that can only do a single fixed task and must be reprogrammed any time your computer or EMR interface changes, Verata Health’s artificial intelligence software is directly integrated with your EMR, freeing up your health care providers to spend more time with their patients, while increasing operating efficiencies for both providers and payers.
The result is faster prior authorization submissions and decisions, while rapidly reducing the turnaround time for patient care. In essence, Verata’s AI-based software eliminates error-prone, time-consuming manual work so that your prior authorization team maximizes your health systems’ ability to deliver faster, better care.
To learn more about Verata Health and how we can streamline your prior authorizations, contact us today.