Rethinking Prior Authorization


It’s 2018, and nearly every day we hear about the promise of technology to revolutionize the way we live and work. Artificial intelligence will turn computing on its head, self-driving cars will make human drivers obsolete, and immune systems will be trained as the best weapon against cancer.

And yet, hospitals, laboratories and other facilities that patients depend on are stuck managing the medical prior authorization process like it’s 1986. Reams of patient files get faxed to the insurance company, so even if the receiving office hasn’t run out of ink or paper (and that’s a big if), the crucial bits of information are buried somewhere in a stack. Or staff members requesting a prior authorization wait on hold – for 30 minutes, an hour, maybe more – in hopes of getting an approval. Sometimes they succeed; other times they find out after all that waiting that a prior authorization wasn’t even required in the first place.

Only a small slice of prior authorization denials are because insurers deem a procedure or scan or genetic test inappropriate. Most denials are due to thing like data being incomplete or incorrectly transcribed or transferred. And when prior authorizations go awry, everyone loses. Requesting facilities can’t effectively manage their revenue cycle and insurers get blamed for causing unnecessary headaches. But most significantly, patients – remember them? – are kept from receiving timely and appropriate care.

It doesn’t have to be this way. We need to rethink medical prior authorization.

The future of prior authorizations isn’t going to be the fax. “Day Sixty Four – Fax Machine” by Yortw is licensed under CC BY 2.0.

Requirements for prior authorization are a fact of life, and that’s likely to continue in the foreseeable future. So why can’t it be a win-win-win? Provider teams should be able to quickly see when a prior authorization is required and submit only the necessary patient information. Laboratories should have the confidence that the tests they run won’t be denied after the fact. Insurers should have a way to pose the necessary clinical questions that are specific to their member groups and plans. And all parties should have a secure system with an audit trail of the process.

PriorAuthNow is rethinking medical prior authorizations. Phone and fax have gotten us this far, but it’s time to vault into the 21stcentury. By connecting with and integrating info existing systems and creating a single, user-friendly experience, the once-cumbersome tasks of securing an approved prior authorization become a digital workflow and recede into the background. With PriorAuthNow, everyone involved in the prior authorization process can refocus on their business and on ensuring excellent patient care.

We have seen the future of prior authorization, and it is automated.