Simplifying the Prior Authorization Process through Automation

Prior authorization workflows are riddled with manual interventions that cost time and revenue for payer and provider organizations. These workflows often create friction points, leading to delayed or disputed authorizations that can hinder patient access to care. The lack of a single source of truth for payer resources can also make responding to provider queries challenging.

To tackle these challenges, Availity joined forces with Blue Cross and Blue Shield of Minnesota, Itiliti Health, and a leading Midwest healthcare provider. Together the organizations worked to develop Intelligent Utilization Management (formerly AuthAI). Intelligent UM enables providers to quickly determine whether a service requires prior authorization. Users can also submit requests, and receive determinations—all within the EHR workflow.

The KLAS case study, ‘Points of Light 2023: Simplifying the Prior Authorization Process through Automation,’ detailed the collaborative effort. The paper outlines the steps taken to streamline the process and highlights the associated outcomes, including:

• Significantly decreased authorization requests from 200 per month to 50 per month due to better visibility into which services require prior authorization.
• Reduced denials for the provider, resulting in a considerable revenue increase.
• Improved provider efficiency and reduced interpretation errors enabled through real-time feedback.
• The payer will experience a more streamlined process, leading to reduced call volume, fewer appeals, and fewer requests for services that aren’t required.
• Positive provider feedback on the ease of use of the Availity portal and associated app.

The case study also offers best practices and looks ahead at what’s next for the future of the authorization process. 

Download the case study to learn about our effort to tackle one of the costliest workflows in healthcare. Learn more about Availity prior authorization tools and services you can use to deliver enduring transformation to your organization.

Jeremy Sacks is Senior Manager of Product at Availity. You can reach him at [email protected].