Prior Authorization & Eligibility

Approximately 16 hours per week or $80,000 per ordering physician per year.  The delay is often over 30 days, impacting the ability to provide the best patient care.

Why so long? – Why so expensive? – Why so complex?

Get results with

Achievable Benefits


Reduced Cost of Labor

Reduce paid physician time from 16 hours per week down to minutes

Decrease the time providers spend on RFAI and requirements gathering


Improved Treatment Speed

Realtime adjudication allows immediate approval of the care plan

More accurate billing with fewer claim denials and faster reimbursement

Faster discharge and beds turnover

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Customer Satisfaction

Better CSAT scores and patient referrals. Competitive advantage

Higher HVBP and HRRP rating for value-based programs

The Most Important Factors in Justification of a Prior Authorization Solution

Adoption of standards will accelerate automation and integration between payer/providers


Improve patient outcomes:  Get your patient orders approved faster.  Reduce adverse events.  Patients receive timely medically necessary care covered and reimbursed by payers.


Cost savings:  Reduce Peer-to-Peer reviews and labor dollars spent on manual data entry.  Improve the accuracy of requests and reduce the number of denied or delayed requests.  Reduce costs tied to fewer hospitalizations and increase patient satisfaction and loyalty.  


Improve efficiency: Automated prior authorization can streamline the PA process and reduce the need for manual work of Medical Assistants and staff.  A policy support tool references standardized clinical guidelines to provide mutual trust between payers and clinicians.


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Reduce errors and denials: Automated prior authorization can help reduce errors using algorithms to verify information against codified medical necessity guidelines.


Patient Retention:  Denials of prior authorization can contribute to patient leakage, particularly if the patient is unable to obtain the necessary treatment or procedure. In some cases, patients may switch physicians or payers in order to obtain timely treatment.


Improved data management: Automated prior authorization systems can help improve data management by capturing and storing data electronically, facilitating data analysis, and reporting tied to quality metrics and physician bonuses.


Regulatory compliance: Automated prior authorization systems can help ensure that physicians and payers are compliant with relevant regulations and policies.

Interested In Our Services?

Experience clinical and financial benefits with a quick turnaround.

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