Prior authorizations are the heart of your interactions with providers and the care they provide your members. Yet, the authorization process is notoriously expensive and inefficient.
Authorizations often involve tedious back and forth communication between providers and payers, and time-consuming manual processes. According to the 2018 CAQH Index, the healthcare industry could save as much as $417 million every year by making authorizations fully electronic, but 51% of all authorizations are still completely manual, while only 12% are fully electronic.
And while prior authorizations can be especially burdensome for providers (they can take as long as 30 minutes each when submitted manually), the CAQH Index suggests payers can dramatically reduce costs, too: “For health plans, the transition from manual to electronic reduces the cost of prior authorization from $3.50 to just three cents.”
According to the CAQH Index, 88% of healthcare IT vendors still don’t support completely electronic authorizations.
But we do. The Healthx Authorization Submissions & Inquiries tool connects you and your providers to a platform, so all your data is in the same place, saving you time and money while reducing opportunities for human error.
Here’s how we simplify authorizations.
1. Reduce Manual Data Entry
One of the most frustrating parts of submitting and evaluating authorizations is finding and entering the right information. It’s also one of the biggest opportunities for human error.
Since our Authorization Submissions & Inquiries tool is part of the Healthx Platform (or can be added to your current platform with our stand-alone Provider Engagement Module), it connects to your provider data and eligibility information. This means that we can pre-populate forms with any relevant information. As soon as your providers start an authorization, all the relevant information is ready to be reviewed, and the possibilities for errors are minimized.
2. Automatically Resolve Requests
Another advantage of integrating your data: you can establish “if this, then that” rules to automatically determine if an authorization is approved or denied, and respond with additional information, such as alternative or prerequisite care recommendations.
This is especially helpful for your most common and easily resolvable authorization requests. Not only does it free your staff to spend their time in other areas, but it also ensures that providers get a response as fast as possible, so your members can get the prompt care they need.
3. Keep Everything Together
One of the biggest obstacles to electronic authorizations is the lack of standards surrounding document submission. With Healthx, when your providers submit authorizations through your provider portal, they can attach or upload any medical documents associated with the authorization, so they don’t have to fax or email any additional materials. All the context you need is in one place.
When you can handle the entire authorization process electronically, time and costs are reduced for both you and your providers. Authorization is ultimately about providing efficient care to your members. There’s no reason why the process of submitting and reviewing authorizations can’t be efficient, too.
By giving your providers a simple and streamlined way to handle one of their most costly transactions, you’re not only helping them to better serve your members— you’re also setting yourself up to be the health plan they prefer to work with.
For more ways you can set up providers for success and learn more about the stand-alone Provider Engagement Module, talk with one of our experts today.