Automated Prior Authorizations helps healthcare provider achieve >98% Successful Authorization Rate
Industry: Healthcare Provider
40% FTEs Repurposed To Higher-Value Tasks
11 Hours Saved Weekly per administrative staff
>98% Successful Authorization Rate On Prior Authorizations
Client Overview:
The client is a large healthcare provider that specializes in cancer, cardiac, neurosurgery, surgery, electrophysiology, orthopedics, and primary and urgent care.
The client noticed that even if the majority of their prior authorizations were eventually authorized, the lengthy process of obtaining authorization approval had a negative impact on patient care. The traditional method of prior authorization was insufficient to address the provider's changing demands, resulting in delays in patient care.
Manual Prior Authorization Proved Insufficient To Tackle The Modern-Day Needs Of The Hospital
The hospital was using the traditional approach of manual prior authorization. The prior authorization process utilized 1 physician hour and 13 nursing hours, along with additional 22 back-office staff hours per week, amounting to $4,100 to $24,000 annually per FTE per physician. This time-consuming process created huge backlogs and delays in care causing patients to abandon treatment.
The client noticed that this lengthy, time-consuming, and expensive process for prior authorization was consuming valuable time and creating scalability issues. Since there are no specific industry norms for prior authorizations, the administrative cost can be enormous. The client needed external expertise to tackle these challenges and streamline the prior authorization process.
AiRo Devised An End-To-End Authorization Platform That Could Automate Prior Authorization
Healthcare automation experts at AiRo designed an end-to-end authorization solution to automate prior authorization with the help of machine learning and AI technologies to assist clinical staff in providing timely medical care. The solution could determine whether the patient requires prior authorization or not. The end-to-end authorization platform used an ML algorithm to recognize CPT or HCSPCS codes, match them up with the payer’s LCD/NCD policies to determine medical necessity, and then submit required data for prior approval.
AiRo’s Solution Helped The Client To Achieve More Than 98% Successful Authorization Rate on Prior Authorizations
AiRo’s solution proved to be extremely beneficial in streamlining the prior authorization process of the provider. The client recorded the following benefits post-deployment:
40% FTEs Repurposed To Higher-Value Tasks
11 Hours Saved Weekly per administrative staff
>98% Successful Authorization Rate On Prior Authorizations
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The AiRo Perspective
AiRo’s solution proved to be extremely beneficial in streamlining the prior authorization process of the provider. The client recorded the following benefits post-deployment:
