Prior Authorization
Transforming Prior Authorization Efficiency
Powerful Solution for Streamlined Prior Authorization Processes
Innovative technology that is transforming the Prior Authorization process, enabling efficient, intelligent authorizations that reduce manual effort and prevent revenue losses by combining rapid processing and precision to enhance revenue cycle management.
Centralized Dashboard to Manage Your Day
Prior authorization dashboard provides a clear view of the authorization process with reporting to track success.
- Dashboard Monitoring: Advanced authorization dashboard communicates the results of all authorizations and which stage they are in. When the automated process has obtained an authorization, the alert informs the staff of the need to call the patient to schedule the appointment, and when additional information is needed to complete the authorization, an alert also instructs the user to contact the appropriate party. If the facility has not responded to requested information or when a request for authorization has been denied, the system generates a corresponding alert for the user. The dashboard also monitors upcoming appointments that do not have an authorization.
- Data Integration: Integrates seamlessly with other billing and electronic health record systems, ensuring that all information is accurate and consistent across platforms. This integration helps in maintaining the integrity of claim data from the point of service to the final billing cycle.
- Comprehensive Reporting Features: Detailed reporting capabilities that help track and analyze the authorization process. These reports are generated automatically, saving staff from manually compiling and reviewing this information.
Reduced Labor Efforts to Eliminate Missed or Rescheduled Authorizations
Prior authorization effectively reduces labor efforts to help eliminate missed or rescheduled authorizations:
- Automate Authorization Checks: The system uses the data collected from the physician’s order to check if an authorization is required and will auto-submit the request for authorization. It then queries the payer to check if it has been approved, pended, or needs additional information.
- Clearinghouse Integration: Utilizing Imagine’s clearinghouse provides many advantages in how direct connections go to the payers, helping manage communication with your staff to complete the authorization process.
- Real-time Eligibility: By verifying patient eligibility and coverage details in real time, the tool confirms that all services provided are covered under the patient’s current insurance plan. This reduces the risk of denials due to eligibility issues.
- Missed or Rescheduled Authorization: One of the biggest losses in revenue is when an authorization is not ready in time for the procedure. Eliminate these misses with an ongoing date of service check, giving the user advanced notice to focus on the authorizations needing urgent attention. The submission processes data in real-time, allowing for immediate action on prior authorization requests. This capability decreases the need for manual tracking and monitoring of the status of requests to help reduce unwanted write-offs due to missed appointments.
Auto-Post Results
Approved authorizations will automatically post to the dashboard for true visibility to support the claim:
- When completed, the facility will receive the authorization approval number “to-from” valid dates, other required data, and an archived screen capture of the Authorization approval or denial letters. The tool will also bring over data elements that are needed in the billing system to submit the claim.
- Stored accurate documentation ensures that all necessary documentation is accurate and complete before claim submission, which can be crucial to getting the claim reimbursed or if an appeal is needed. Accurate documentation supports the authorization and claim, providing straightforward evidence that services were necessary and approved, thereby reducing denials.
Essential Features of AI-Powered Prior Authorization Solutions
Automated Authorizations
The system automates the entire process of submitting and managing prior authorization requests, reducing the need for manual intervention, and minimizing human error.
Real-Time Eligibility Verification
Performs real-time checks for patient eligibility and insurance coverage before services are rendered, ensuring that all claims are properly backed by necessary authorizations.
Compliance Management
Helps ensure compliance with diverse and payer-specific requirements and regulations, thereby reducing the chances of claims being denied due to non-compliance.
Streamlined Communication
Facilitates improved communication between healthcare providers and insurance payers, helping to quickly address any discrepancies or additional requirements before claim submission.
Data Integration
Integrates seamlessly with existing billing systems and electronic health record (EHR) systems, ensuring that data remains consistent and accurate across all platforms and throughout the entire billing cycle.
Automated Alerts and Notifications
Users receive timely alerts and notifications about the status of authorizations, including reminders and updates, which helps in keeping the authorization process on track.
Reporting and Analytics
Provides comprehensive reporting capabilities, allowing users to generate detailed reports on the authorization process. These insights can help identify bottlenecks and improve process efficiency.
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