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INSURANCE PREAUTHORIZTION SOFTWARE

Hospital Lab Outreach, Clinical Labs, Molecular Diagnostics Labs,
Pathology Groups, Physician Practices, and Radiology Services

  • Fast
  • Secure
  • Intuitive
  • Intelligent
  • Reduce Denial
  • Reduce delays in care
  • Reduce Administrative burdens
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The Challenge

Per AMA 2019 survey about Preauthorizations (PA):
  • On average physician practices complete 33 PA’s per physician per week
  • Physicians and their staff spend an average of almost two business days (14.4 hours) each week completing PA’s
  • Almost one-third 30% of physicians have staff who work exclusively on PA’s
  • 86% report PA burdens have increased over the last 5 years
Identifying The Challenges
  • The electronic preauthorization (ePA) program is the standard for insurance companies to follow however about 20% elect to participate in the program with the remaining 80% maintaining policies and guidelines that vary with each insurance company thereby creating a cumbersome workflow to follow.
  • The paper preauthorization (PA) is a labor intensive process requiring physician staff to follow insurance guidelines often requiring the employee to call, fax, use multiple payer portals, and collect supporting documentation. This clunky manual process is not a one-time-effort, often staff have to follow-up multiple times to status pending cases.
  • The challenges facing the physician practice becomes compounded with genetic and molecular laboratory providers requiring the PA prior to testing. This type of testing is becoming more common which will continue to put stress on the physician office to obtain the PA or start the request for a PA.
  • Radiology groups need the PA before services are rendered.

The Solution

01
Automation of the Process

The software provides a systematic workflow approach to manage preauthorization’s across major payers and utilization managers. Eliminates calling payers, faxing, or navigating online portals to submit and track the authorization. The software enables providers to automate a number of manual steps in the PA process.

02
Predictive Intelligence

Predict denials before they happen. Some treatments are more susceptible to medical necessity scrutiny than others, which can lead to delays in care. The software enables providers to optimize operations and patient scheduling through real-time analytics, so you can predict if and when the services will get approved.

03
Transparency

The software keeps track of the payer requirements, no more chasing payer requirements. Maintaining a payer’s medical necessity criteria is time consuming and often confusing whether a service requires a PA. The software enables providers to discover in real-time specific payer requirements and clinical criteria for a PA request. The software performs ePA to payers that participate in the ePA program.

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