To overcome reduced call center capacities, some payers and providers have turned to portal messaging – a simple but effective concept. Leading portals offer enhancements that far exceed what’s available through email messaging or simple web chats, such as security, HIPAA compliance and logging and recording capabilities.
Automated prior authorization: Prior authorizations represent a significant expense for payers and providers. In part because they involve conversations between two clinicians attempting to parse out the rules around various procedures and referrals. Prior authorizations carry a heavy cost for patients as well, in the form of delays in obtaining needed care and decreased satisfaction. Interestingly, research has shown that most provider calls regarding prior authorizations are not associated with requesting authorization but rather focused on whether authorization for a certain procedure is even required.
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This process is crying out for automation, with industry-leading solutions doing just that. Via automated prior authorizations, providers log into a portal and determine whether authorization is needed simply by entering three discrete bits of data; group number of the patient’s health plan, procedure code and date of service. Automated prior authorizations also help free staff to focus on more high-value, patient-facing activities while increasing patient satisfaction and expediting the entire scheduling process.
A bright spot
While parts of the U.S. begin to ease sheltering-in-place restrictions, it’s apparent the pandemic has not yet run its course, with several states reporting post-Memorial Day spikes in COVID-19-related hospitalizations. As the healthcare industry continues to grapple with the pandemic, however, increased payer – provider collaboration (much like greater utilization of telehealth) has emerged as a rare bright spot that points the way to a future of lower costs, higher efficiency, higher patient satisfaction and less hard copy paper work to manage.
About the author: Steve Jax is the alliance manager of strategic payer relationships for Availity, the nation’s largest health information network.
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