Easing the Burden of Prior Authorization
The heart and driving force of any healthcare provider’s job is quick and effective care. Advances in healthcare technology, services, and medicine are vital aspects of ensuring effective care. However one of the biggest barriers to care is unaffected by these changes, and that’s accessibility.
Accessibility as a Barrier to Advanced Care
As medicine advances and is perfected, it becomes increasingly important that people get the care they need. One big tool in this happening today is prior authorization. Prior authorization is the process of healthcare providers requesting approval from a patient’s insurance for specific care. Rudimentary and commonplace services don’t require prior authorization, but some of the most important care does.
Today, one in three providers say prior authorization delays have led to an adverse event for patients. In other words, not being able to obtain authorization has regularly inhibited healthcare providers ability to do their job effectively. This is unsurprising when taking a closer look at the prior authorization process.
The Challenges of Manual Submission
After all, manually submitting prior authorization is a cumbersome task, with several opportunities for mistakes and delays to arise. First, healthcare providers have to check their patients’ insurance details. Depending on the insurance, this could be a simple digital check, or the time waster of waiting in a call queue.
After this the patient’s file has to be examined for compliance and to see if they meet authorization guidelines. Then the healthcare provider submits the request, and follows up regularly to start care as quickly as possible. If anything goes wrong at any point in this process, the care plan has to be amended and submission repeated.
The Inefficiency of Manual Processes
In the case that authorization is accepted, approval documents are added to patient files, information is updated, and care begins. The process, while not challenging, is cumbersome and tedious to healthcare providers. In an industry that is understaffed and overworked, manual submission is ripe for mistakes and time wasting.
Currently, 35% of providers opt to hire someone to deal explicitly with prior authorization. The time and money lost in the case that anything goes wrong is worth more than a new staff member. It’s a form of administrative burden that is not only time consuming, but frustrating for caretakers.
The Need for Affordable Solutions
Unfortunately, not all healthcare providers can afford hiring someone to deal with prior authorization. This is where the importance of digitally and AI-powered submission comes in. AI-powered prior authorization process automation is a service which fills an administrative need cheaply and effectively. Healthcare workers do not want to deal with prior authorization, it’s just a part of the job. AI submission is cheaper, more consistent, and quicker than manual submission.
How AI Transforms the Prior Authorization Process
This is because the automated AI authorization process covers all steps cohesively. First, patient data is retrieved, then an AI voice call is made to see if prior authorization is needed. If it is, then patient documents are checked for eligibility, and finally the request is made. This all happens quickly and with little to no human input.
Handling Rejections with Automation
Most notably, in the case that authorization isn’t approved, the automated AI will respond and submit additional information. Finally, the AI will automatically update the medical records and notify the healthcare provider that care can proceed. Automating this process, from top to bottom, could save hundreds of millions. Current AI models are predicted to automate the process 82% of the time. The hours this can save for even one healthcare provider are staggering.
Balancing Automation with Human Oversight
Of course for particularly complex issues, the AI has a queue which will defer the request to a human worker. It’s not meant to fully replace humans, but instead to ease the burden. All in all, automating the process accomplishes the most important goal for any healthcare provider, better care. Prior authorization being submitted quickly, consistently, and cheaply means more people get care faster. It’s not a perfect solution, and requires a human touch, but it’s one process which AI can truly help with. After all, people don’t get into healthcare to submit insurance requests. So why not make their jobs, and the lives of the patients they serve, easier?
Source: Orbit Healthcare
