Prior authorization is an essential process in healthcare, requiring providers to request approval from insurance payers for specific services. While intended to control costs and ensure medical necessity, it often becomes a bottleneck in patient care. Recent surveys indicate that one in three providers experiences delays in processing prior authorizations, leading to postponed appointments and treatments. This raises the question: how can the authorization system evolve, particularly through technology, to minimize inefficiencies and improve patient access? Learn more about prior authorization process automation below.
Current Issues in Prior Authorization
Traditionally, prior authorization is a manual and cumbersome task. Staff must verify patient insurance and medical histories, submit requests, and follow up with insurers. This can take 15-20 minutes per request, and if denied, the process becomes even more complex, involving additional documentation and appeals. This manual method not only consumes valuable time but also places a heavy administrative burden on providers, costing up to $11 per authorization and leading many to hire dedicated personnel for this task.
The delays from these inefficiencies significantly impact patients. Research shows that prior authorization can lead to treatment delays, with some patients facing a 100% likelihood of postponement. This can result in serious consequences, including a 25% chance of hospitalization and a 19% risk of life-threatening events. Despite these risks, only one in five physicians regularly appeals denied authorizations due to time constraints, leaving nearly 70% of patients and providers stuck with outdated methods.
Prior Authorization Process Automation
To address these challenges, innovative solutions in prior authorization process automation have emerged. Orbit’s AI-powered automation streamlines the prior authorization process, providing substantial time and cost savings. The system has saved providers approximately 60% of existing costs, equating to about $449 million in savings across the U.S. healthcare system. Automated processes can complete authorizations in as little as five minutes, significantly reducing the hours spent on manual tasks.
The benefits of automation include improved patient experiences, streamlined workflows, enhanced accuracy, and substantial cost reductions. Providers can save up to 24 hours of wasted time daily, reclaiming nearly 12 hours per staff member each week for critical patient care tasks.
In Summary
The complexities of prior authorization impact both providers and patients. However, technological advancements, such as Orbit’s automation solutions, offer a path to transform this time consuming and inefficient process into a more accurate, and patient-friendly system. Embracing these innovations can improve access to care, reduce administrative burdens, and enhance overall patient outcomes. Overall, the technology in the space can only evolve and improve, and Orbit’s automated system emerges as a future forward solution to the present issue.
Source: Orbit Healthcare
