Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

 Among the processes that influence the healthcare revenue cycle, pre-authorization stands out—but not in a good way. It lacks the foundation of a widely-adopted electronic data exchange, resulting in repeated manual, ad hoc methods of securing and confirming payer approval for non-emergency medical services.

So where does authorization break down? And how can it be fixed?

Understanding payer-specific pre-authorization requirements and monitoring for confirmation of payer decisions are a few of the core activities that suffer from a lack of consistency. They rely on disjointed, manual processes that are costly—in both time and money. But they don’t need to be so complicated and inefficient, and can benefit from process improvement and automation.

Automating components of pre-authorization enables providers to screen and verify consistently across the organization while supporting the centralized pre-authorization function. So, what can healthcare providers expect to gain from automating pre-authorization? To put the potential impact in perspective, consider what has been achieved through electronic claims filing. The elimination of duplicative reviews, administrative savings, and fewer denials translate into significant savings.


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