Electronic Prior Authorization Vendors Streamline Healthcare Processes

Electronic prior authorization vendors are revolutionizing the way healthcare processes work, saving time and reducing frustration for both patients and providers.

By automating the prior authorization process, vendors like Cotiviti and Change Healthcare can reduce the average approval time from weeks to just a few minutes.

This streamlined process allows clinicians to focus on what matters most - patient care.

According to Cotiviti, their platform can reduce the prior authorization approval time by up to 90%.

Using an electronic prior authorization (ePA) vendor can bring numerous benefits to health plans and pharmacy benefit managers (PBMs). You can achieve a significant reduction in full-time equivalent (FTE) staff.

Health plans and PBMs have successfully leveraged ePA vendors to enhance PA Volume by streamlining the prior authorization process. This has led to increased efficiency and compliance.

By adopting ePA, you can improve the patient experience by reducing the time it takes to receive authorization. This is particularly important for patients who require ongoing treatment.

Health plans and PBMs have seen a decrease in FTEs after implementing ePA vendors. This is a direct result of the automation and standardization of the prior authorization process.

ePA vendors have helped health plans and PBMs improve compliance with regulatory requirements. This is achieved through the standardized and automated process of prior authorization.

Electronic prior authorization is a game-changer for healthcare organizations, allowing them to reduce operational costs and call volume to health plans and benefit managers.

PromptPA is a self-service, web-based solution that enables pharmacies, members, and providers to request prior authorizations electronically, reducing the need for phone calls and paperwork.

The process works by transmitting a dynamic electronic question set tailored to the medication from the benefit plan to the electronic health record (EHR), guiding staff through entering the required clinical details and submitting attachments if necessary.

Surescripts lets health plans quickly send approvals, denials, or requests for more information based on the submitted information, making the process more efficient and reducing delays.

Patients can get their prescriptions sooner, and healthcare organizations can alleviate frustration and delays by using a fully integrated solution that lets teams proactively initiate requests and receive quick responses within the EHR.

Surescripts displays only the patient and treatment questions that are truly needed for a decision.

This streamlined approach helps reduce unnecessary questions and paperwork, making the prior authorization process more efficient.

Once the PBM receives the data and makes a determination, approvals typically arrive within minutes.

This rapid turnaround time ensures that patients can get the medication they need without unnecessary delays.

If you receive denials or requests for more information, it's essential to work with the plan to resolve the issue.

By collaborating with the plan, you can resolve any issues and get the patient the medication they need.

Surescripts enables faster prior authorization decisions by securely delivering plan-specific question sets, decisions, and responses to provider workflows.

This integration helps eliminate the inefficiencies and administrative burden of manual prior authorization, making the process smoother for everyone involved.

Automatically sending question sets, receiving answers and attachments, sending responses, and initiating renewals can also help streamline the process.

Submitting a request for prior authorization can be a straightforward process. You can use the PromptPA self-service solution to request prior authorizations electronically, initiate renewals, and check the status of requests using any web browser.

To ensure a timely decision, please submit all documentation needed to make a decision. Lack of information may delay the decision-making process and may result in an authorization denial unless all required information is received.

If you're a prescriber, you can use the CoverMyMeds prior authorization process for Medicare Part D patients. Here's an overview of the steps:

The Surescripts Prior Authorization Portal can also ease the process for those without an integrated solution. Staff are guided through entering the required clinical details and, if necessary, submitting attachments.

Electronic prior authorization vendors have made significant strides in streamlining the prior authorization process for healthcare providers and payers. Surescripts is a pioneer in bringing prior authorization into the familiar workflows care teams use within their EHRs and other technology platforms.

Surescripts offers a dynamic electronic question set tailored to the medication from the benefit plan to the EHR, guiding staff through entering the required clinical details and submitting attachments. This helps reduce the administrative burden and delays associated with prior authorizations.

PAHub is a HITRUST-certified solution that streamlines and controls all clinical, compliance, and administrative aspects of prior authorization at the point-of-care. It leverages the latest technologies for data mining, data analytics, and advanced decision support trees to automate the end-to-end prior authorization process.

Cohere Health's Unify platform is a configurable end-to-end prior authorization solution that speeds up access to care by 70% with 63% lower denial rates. The Intake solution digitizes requests from all sources and includes intelligent form completion and portal access.

Arrive Health, previously known as RxRevu, offers automatic electronic prior authorization alongside real-time medical and pharmacy benefit information in its Direct care access solution. Direct integrates with the EHR to present eligibility and accurate pricing information within ordering workflows.

Here are some of the top electronic prior authorization vendors:

Experian Health's Authorizations solution guides providers and support staff through the prior authorization process with minimal manual involvement, automating everything from inquiries to status monitoring.

Electronic prior authorization vendors are making a significant impact on the time it takes to process medication authorizations.

Real-world results show that electronic prior authorization can save up to 45 minutes per medication authorization in some cases.

Many healthcare providers are experiencing a substantial reduction in processing time, with some finishing 10 electronic prior authorizations in the time it takes to finish one or two manually during a day.

This is a testament to the efficiency of electronic prior authorization vendors.