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Reducing Administrative Burdens with Automated Prior Authorization

In the dynamic and complex world of healthcare, payers are consistently on the lookout for effective strategies to streamline operations and mitigate administrative burdens. A pivotal area of focus is the domain of prior authorization. The advent and integration of automated prior authorization technology are revolutionizing this sphere, markedly enhancing efficiency and fostering improved healthcare outcomes. Let’s take a closer look at how automated prior authorization is disrupting the industry.

Exploring the Concept of Automated Prior Authorization

Automated prior authorization is a technological innovation designed to simplify and expedite the process of securing approval for certain medical procedures, medications, or services before they are provided. This advancement is a leap from the cumbersome, error-prone manual methods of prior authorization that have historically plagued healthcare administration.

Image of doctor on laptop clicking holographic icons that are floating in front of him

The Imperative for Automation in Prior Authorization

According to a 2021 AMA survey, 93% of physicians reported that prior authorizations delay patient care. Automating the process can significantly reduce turnaround times and ensure patients receive timely access to necessary treatments. 

When Blue Cross Blue Shield implemented technology to streamline prior authorization, they discovered that approval time was reduced from an average of nine days to an average of less than one day. A significant difference!

Automated prior authorization offers a wealth of benefits including:

Enhanced Time Efficiency: Traditional prior authorization processes are notoriously slow, mired in back-and-forth communications and extensive paperwork. Automation introduces a swifter, more streamlined approach, significantly shortening the duration from request submission to decision.

Cost-Effective Operations: By automating prior authorization, administrative costs, often inflated by manual processing, are substantially reduced. 

Accuracy and Uniformity: Automated systems minimize human errors and provide a consistent approach in the authorization process, upholding high standards of operational integrity.

Strengthened Provider Relationships: Efficient authorization processes lead to improved interactions with healthcare providers, facilitating timely patient care.

Optimized Patient Care: With accelerated authorization, patients gain quicker access to necessary treatments, directly impacting and improving health outcomes.

The Mechanics of Automated Prior Authorization

In an automated system, this process is significantly more efficient. Here's how it typically works:

Integration with Electronic Health Records (EHRs): Automated prior authorization systems seamlessly interface with EHRs, allowing for an efficient and accurate exchange of patient information and requisite medical data.

Algorithm-Driven Decision Making: These systems utilize sophisticated algorithms to evaluate the necessity of a requested service against the payer’s established policies and guidelines.

Real-Time Processing Capabilities: Requests are processed instantaneously, offering immediate feedback regarding the authorization status.

Ongoing Monitoring and Adaptation: Automated systems are designed to continually track changes in healthcare regulations, guidelines, or policies, ensuring up-to-date and compliant decision-making.

A human hand touching an index finger to a robot index finger.

Exela’s Pioneering Prior Authorization Services

In a healthcare landscape where certain medical services necessitate prior authorization, managing these requests can be a daunting task for providers. Exela’s Prior Authorization solution steps in to alleviate this burden with our sophisticated blend of advanced digitization, automation technologies, and an expert workforce. 

With over three decades in the healthcare industry, Exela's team is not only seasoned but also consistently abreast of current best practices and regulations. Their expertise ensures that prior authorizations are managed correctly, adhering to both plan rules and industry standards.

At the heart of Exela’s service is its cutting-edge technology. Using Robotic Process Automation (RPA) tools, including OCR for swift and precise data capture and programmable rule sets for reliable outcomes, Exela transforms and streamlines the prior authorization process, setting a new standard in healthcare efficiency.

Exela's Prior Authorization solution is designed with user experience in mind. The user-friendly dashboard interface simplifies navigation and management of prior authorization requests. Furthermore, the multi-tenancy environment ensures that the system can efficiently handle multiple clients or departments within a single, streamlined framework.

Central to Exela's Prior Authorization solution is the advanced portal that facilitates bi-directional communication between providers and payers, streamlining the request and response process. This feature ensures efficient and clear exchanges, crucial for timely decision-making and enhancing the overall efficiency of the authorization process

Recognizing the critical nature of time in prior authorization, Exela excels in optimizing cycle times. By creating electronic content and setting up efficient online request platforms for providers, Exela significantly speeds up the decision-making process without compromising on accuracy.

An extensive audit trail is integral to Exela’s services, providing detailed records of all actions and decisions. This feature ensures transparency and accountability, crucial for regulatory compliance and maintaining trust with providers and patients. Learn more about our Prior Authorization solution today!

Looking Forward: The Future of Automated Prior Authorization

The trajectory of automated prior authorization is one of continuous innovation and refinement. Future enhancements may include more sophisticated AI algorithms, deeper integration with various healthcare systems, and advanced analytics capabilities. As technology evolves, so too will the capabilities and benefits of automated prior authorization, solidifying its role as a cornerstone in modern healthcare administration.

Embracing Automated Prior Authorization in Healthcare

Automated prior authorization is more than just a technological enhancement; it represents a fundamental shift towards a more streamlined, accurate, and patient-centric healthcare system. For payers, embracing this technology not only alleviates administrative burdens but also sets the stage for a more efficient and effective healthcare delivery model. In an era marked by digital transformation in healthcare, automated prior authorization emerges as a vital tool in optimizing healthcare processes, promising a brighter future for both providers and patients alike. Ready to elevate your prior authorization process? Reach out to us today!