From Frustration to Satisfaction: How to Transform the Prior Authorization Experience

In today’s healthcare landscape, managing prior authorizations is a necessary—but painful—step in the delivery of medical and behavioral health treatment. Not only are prior authorization processes often manual and error-prone, but the administrative burden diverts valuable time and resources away from patient care.

More concerning, delays in obtaining approval can postpone critical care, causing health conditions to worsen and impacting outcomes particularly for vulnerable populations. And if care is denied, whether for failure to meet criteria or inadequate documentation, the appeals process can be complex and time-intensive, further delaying essential treatments.

The right technology can streamline preauthorization processes, minimizing the administrative burden and improving outcomes while reducing costs for plans, providers, and members.

Minimizing Administrative Overhead

Reducing administrative overhead through automation eliminates errors and makes the prior authorization process run more efficiently and consistently. Look for a technology that optimizes the use of clinical resources. That means minimizing clinical touches throughout the process—instantaneously approving treatments that don’t require review, and efficiently routing requests based on authorization type, process stage, type of service, and priority. This approach keeps clinicians focused on patient care—which saves money and improves outcomes. As important, it simplifies and speeds processes, improving your quality metrics and patient and provider satisfaction.

Clinically Sound Decision-Making

Informed care leads to the best outcomes. Tools that enable you to integrate with decision support such as MCG or Interqual guidelines within workflows enables your staff to efficiently make clinically sound decisions using objective criteria. Care guidelines help you deliver appropriate, evidence-based treatments while minimizing the overuse or underuse of medical resources. Having up-to-date, relevant  information available within the workflow saves clinicians time, particularly if workflows are used to automate next steps.

Comply with Quality Requirements

The best technologies offer quick processing, with automated workflows that help you meet timeliness requirements and other quality performance metrics so you stay in compliance. Ideally your solution will be aligned with NCQA, CMS, URAC, and other regulatory requirements to make compliance, audits, and accreditation processes easier. Plus, it should be configurable to meet your needs, not only supporting different programs with different criteria and auto-routing options, but also configurable to support changing business needs and regulatory requirements so that your technology evolves with your needs.

Improve Member and Provider Satisfaction

While focused on managing costs and ensuring appropriate utilization of resources, prior authorization can have a significant impact on satisfaction. Delayed care, poor communication, and cumbersome administrative and appeals processes can be frustrating to everyone involved. Efforts to streamline processes and minimize the administrative burden—plus improve communication across the continuum—can contribute to a more positive healthcare experience for members and providers alike.

Look for a technology that brings people together, streamlining processes and data to put the right information in front of the right people at the right time to ensure good communication and improve outcomes.

Incedo Solves Prior Authorization Headaches

Incedo utilization management technology excels at automation for medical and behavioral health management—reducing points of friction and replacing repetitive, manual tasks to speed decision-making so that your organization can prevent delays and meet quality performance requirements.

Learn more about how Incedo can help you optimize your prior authorization process to speed turnaround, reduce the administrative burden, and improve the patient experience.


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