Prior authorization is an important step in helping insurance companies to determine whether or not to cover a procedure, service, or medication. There are several challenges that the traditional process presents, leading 1 in 3 providers to experience delays in patient care. This system was originally designed to protect resources and save money, but is in need of change to continue to be effective.
The current manual method for prior authorization is tedious and prone to error, as all steps have to be completed by humans. This is time-consuming and can lead to dangerous side effects. Not only are providers losing money and resources, but patients may be denied critical care or be forced to pay out of pocket for necessary procedures. Fortunately, experts are rolling out an AI-backed method for prior authorization process automation. This new system will be able to retrieve and update patient data in real time and even facilitate phone calls. Using technology to carry out these operations will eliminate error and alleviate the potential side effects of manual authorization.
As many as 70% of current prior authorization processes still rely on manual labor. The time is now for the healthcare system to make a switch, benefitting insurance providers, medical professionals, and patients in need alike.
Source: Orbit Healthcare