Solving the Prior Authorization Dilemma Has Many Benefits
Prior authorizations (PA) within the U.S. healthcare system were created to improve patient safety and reduce unnecessary costs through the application of evidence-based care best practices.
However, the industry as a whole has acknowledged that the current methods for managing PAs are marked by a lack of standardization and a dearth of widely adopted technologies and processes, which have had a significant negative impact on patient care.
Typically involving communication and collaboration among patients, providers, third-party administrators and payers (to name just a few of the key actors), the PA process is handled many different ways depending on the policies, processes, tools and capabilities of those involved.
Addressing the PA dilemma can be solved by:
- Automating the evaluation of patient data at the time of the PA request
- Establishing standards for provider/payer clinical exchange to enable the secure sharing of critical health information between EMR systems and Adjudication systems
- Collaborating to creating scalable solutions to ease the burden of the process for all parties
- Implementing technologies, such as Artificial Intelligence (AI), that delivers health information in real-time
These are a few of the initiatives we’re working on to take the headache out of prior authorizations. Find out more by completing the web form or contacting us at: email@example.com
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The Prior Authorization Challenge white paper is the first in a series that will track the progress being made by the Innovation Messaging Group (IMG) and its partner organizations.
The Prior Authorization Challenge – Free White Paper
Find out how technology can help create a better connected and automated infrastructure to reduce the administrative burden and costs associated with the current PA process.
* The Impact of the Prior Authorization Process on Branded Medications: Physician Preference, Pharmacist Efficiency and Brand Market Share. Frost & Sullivan.
Dan Kazzaz has 30+ years of experience in automating business-to-business (B2B) data interchange. Dan has been an active participant, chair and board member of the American National Standard Institute’s (ANSI) Accredited Standards Committee (ASC) X12 – the federally mandated organization for healthcare exchange standards (EDI).