Automation in Prior Authorization For Better Medical Adherence
Every year, more than 185 million medical prescriptions are still getting rejected with prior authorization. An effective streamlining of the PA process that connects the provider, pharmacists and the PBMS/payers improves time to medical therapy and reduce the chances of prescription abandonment.
- Simple systems that provide practice management sanity, ensuring quicker turnaround time rather than faxing mails, flexibility that enhances patient care approach is necessary! Beating the old way of calling and filling out paper forms and substituting it with effective electronic prior authorization is still a long way to go!
- Healthcare is still extremely local in all senses, which means each segment has its individual set of payers and providers. The payers have their own web portals that can be quite clunky and only matches with their internal workflow.
- What we need today is expert intervention and a combination to leverage the benefits of technology in the best possible manner. While it is true that a manual process is quite expensive and costs around $10.78 per transaction versus a $2.07 for an electronic transaction for prior authorization.
- Yet, with changing local business environment, keeping pace with today’s EMR and practice management systems, it is imperative for you as a practice to make the best use of technology and combine it with expert resources that can demystify your prior authorization challenges in the best possible manner!
We already know that prior authorization is costing the healthcare industry $32 billion annually. With the expected Medicare and Medicaid cuts, you have to employ the right checks and balances, make your processes and best practices up to date to keep up the flow of your revenue cycle.
Unless, you make the right plans now, make deliberate attempts to reduce your administrative burdens and time consumed with prior authorization, it can be quite a looming danger to your future financial outcome! Automation today in the process of eligibility verification, referrals and prior authorization will be a key mandate to achieve!
Resolve your practice management pains with the Sun Knowledge advantage
Sun Knowledge has developed its very own platform "prior auth online" incorporating the best practices of the leading practice management systems in the marketplace. We provide our stand alone prior authorization services for $7 per hour. Our simple processes, expert team of prior authorization reduces your practice management worries with 100% accuracy.
We ensure all submission of PA requests on the same day. At present, Sun Knowledge processes almost 50,000 prior authorizations on a monthly basis making us your desired vendor to handle any amount of PA volume.
Moreover, we provide you complete transparency and accountability with gathering of procedural information from provider and patient, determining the eligibility coverage, validate and initiate PA request with proactive payer communication, follow up with ordering physicians for additional and relevant documents, checking the auth status and updating the outcome in the PM/billing system.
A case study in prior authorization (Botox)
Our client needed us to obtain prior authorizations for a quasi medical product like Botox, which is primarily used in for cosmetic purposes. We provided our persistence, proactive persuasion with our extensive knowledge of the payer protocols and Rx caveat. As it required more effort than any other case involving conventional medication process, we completed all the tasks with:
- Verifying eligibility
- Initiating authorization
- Following up on the request
- Obtaining and acknowledging authorization
- Scheduling the drug delivery
Get in touch with our experts! Let us give you a complete demonstration of our best practices, share with you our references from over 100 clients. We guarantee you complete account management support and great process adherence as a 100% HIPAA compliant organization!