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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 help tackle these challenges and address the associated points of friction, 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 a more automated, self-service solution, known as Availity AuthAI, that enables providers to quickly determine whether a given service requires prior authorization, submit requests, and receive determinations—all within the EHR workflow.

The collaborative effort was detailed in the KLAS case study, “Points of Light 2023: Simplifying the Prior Authorization Process through Automation.” 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.
  • A more streamlined process for the payer, 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 advice on best practices for other organizations to replicate and looks ahead at what’s next in the vision for the future of the authorization process. 

Download the case study to learn more about our collaborative effort to tackle one of the costliest and most manually driven workflows in healthcare. Learn more about the full suite of 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. He can be reached at [email protected].