Editorials by Jorie

AI Powered Prior Authorization Automation in Healthcare

Prior Authorization is a process that must be completed prior to services or treatments being administered. some insurers save money by implementing more prior authorization, which may reduce healthcare costs for employers who choose plans with more prior authorizations. This part of the process, Prior Authorization is a routine part of patient care and won't be going anywhere anytime soon. Prior Authorization is commonly a manual, time consuming process involving multiple steps.  

The Prior Authorization workflow automates time-consuming  manual workflows for payers as they update their rules, navigate different portals, and query the status of prior authorization submissions. Unless they keep pace with evolving payer requirements, providers risk delays in patient care and claim denials. As one survey respondent said, "Anything that can automate, simplify and perfect this process would be appreciated."

Prior authorization automation can help screen and verify consistently across the organization, supporting centralized prior authorization workflows. Automated screening and verification embedded in workflow can drive higher reimbursement, fewer denials, and greater providers satisfaction. Prior authorization automation is already connecting providers to millions of payers with millions more electronically linked payers expected to be using prior authorization automating in the coming future.

According to industry experts, one of the best wats to improve prior authorization is by automating tasks through technology. These automated tools identify patient accounts and collect authorization information to expedite prior authorization. A "bot" is a software tool that automates certain repetitive tasks, such as filling out forms on websites or collecting claims for prior authorization automation. Prior authorization is automated with a AI tool that captures the payer's authorization requirements and electronically enters them into the providers patient access system. A picture of a signed authorization provides tangible proof that the authorization has been signed. This streamlines the financial clearance process and helps ensure compliance with service level agreements.

A streamlined prior authorization automation process can save providers millions, if not billions of dollars each year. In turn, providers can see reduced bad debt and write-offs or a need to chase revenue on the back end. Fast and accurate authorizations help patients get the care they need when they need it, reducing cancellations and multiple rescheduling's. This can help improve the doctor-patient relationship and enhance patient satisfaction.

Providers should not rely on inefficient or outdated processes, especially when those processes have a direct impact on patient outcomes and the patient experience. Some states are in the process of passing legislation to reduce payer turnaround times for authorizations, providers can take steps today to improve their prior authorization processes.

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