It’s time to take prior authorization reviews from days to seconds. Introducing Availity AuthAI.
Availity AuthAI is transforming prior authorizations by tackling the problem at a critical touchpoint—determination of medical necessity. With insight captured from clinical data and a health plan’s unique medical policies, AuthAI eliminates the manual review process, and—in most cases—can recommend approval in seconds. By automating this key function, AuthAI significantly reduces authorization processing time, freeing health plans and providers to focus on optimizing patient care.
Reimagining Utilization Management
Solving the medical necessity question
Unlike many healthcare transactions, prior authorization is not a simple inquiry and response. It’s a complex conversation that evaluates medical necessity against a member’s medical record and a health plan’s guidelines. AuthAI streamlines this process with a data-first workflow—collecting clinical data at submission and evaluating it against a health plan’s medical policies before recommending a decision or pending the request for further review – automating up to 80% of the UM workload while dramatically reducing administrative costs for payers.
Leveraging the power of AI and NLP
Unlike other solutions in the market that rely on statistical modeling based on historical data, AuthAI harnesses the power of AI, NLP, and clinical data. Developed and refined over several years, this proprietary utilization management engine delivers speed and accuracy to medical necessity reviews for providers and near real-time decisions at the point of care for patients.
Capturing and analyzing clinical data
Obtaining relevant clinical documentation is one of the most time-consuming aspects of the utilization management review process. AuthAI eliminates this administrative burden for providers and health plans by automatically extracting clinical data from medical records and comparing it against the payer’s specific medical policies to make a determination recommendation or to pend for further review.
Learn how electronic, automated, and intelligent tools are changing the authorizations game
Prior authorizations, a critical tool of utilization management, are necessary for establishing checks and balances in the healthcare system. Unfortunately, too many providers and health plans consider the prior authorization process, which relies heavily on manual interventions and analog technologies, burdensome and a potential impediment to timely patient care. This white paper focuses on Availity’s suite of solutions that streamline the critical functions of the prior authorization process and, thanks to API protocols, empowers providers to manage prior authorizations and respond to prompts in their workflow.
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