Prior authorization process automation in healthcare involves a provider requesting approval from an insurance payer before delivering specific services. While this process aims to control costs and ensure medical necessity, it often results in significant delays in patient care. A staggering one in three providers report that these processing delays hinder timely patient treatment, raising concerns about the overall efficacy of the authorization system and its underlying technology.

The World of Prior Authorization

Traditionally, prior authorization is a manual, cumbersome process. It requires checking patient insurance details and medical charts, submitting requests, and following up with insurance companies. This often involves lengthy phone calls, waiting in queues, and navigating complex online portals, leading to an estimated 15-20 minutes spent on each request. If a request is denied, additional documentation or an appeal letter must be prepared, further complicating the process.

In contrast, an automated prior authorization system significantly enhances efficiency. Automated solutions can retrieve essential patient data, validate information, and prepare authorization requests in a fraction of the time. These systems also update medical records automatically and track the status of requests, streamlining workflows considerably.

The complexities and rigidity of the current prior authorization system have profound implications for healthcare. Providers face rising operational costs, with 35% hiring additional staff solely to manage prior authorizations. Manual processes can cost around $11 per authorization, and nearly 93% of physicians report experiencing high administrative burdens related to these requests. The impact on patient care is alarming; delays in authorization can lead to a 100% increase in time to access care, a 25% chance of hospitalization, and even life-threatening events in 19% of cases. Furthermore, 9% of patients risk long-term disabilities due to these delays.

Enter New Innovation

Compounding the issue, many physicians express concerns about the denial rates of prior authorizations. Approximately 27% say their patients’ requests are often denied, while 35% report that the criteria for authorization are rarely evidence-based. In recent years, nearly three in four doctors have noted a significant increase in denials, yet only one in five consistently appeals negative decisions due to time and resource constraints.

In this challenging environment, Orbit has emerged as a transformative solution. The company’s AI-powered prior authorization automation system has demonstrated remarkable effectiveness, saving providers approximately 60% on existing costs and generating an impressive $449 million in savings across the U.S. healthcare industry. Beyond cost reductions, Orbit’s technology enhances patient experiences by expediting care delivery.

Conclusion

By eliminating inefficiencies, Orbit can save provider groups operating with five or more prior authorization team members up to 24 hours of wasted time each day. Processing a patient’s information and scheduling appointments takes just five minutes, a stark contrast to the manual approach. The automated system reduces turnaround times by 55%, saving an average of 11 minutes per authorization. Additionally, it improves accuracy by capturing demographic and insurance data without human error, and decreases the labor dependency, allowing staff to reclaim nearly 12 hours per week.

Overall, Orbit’s automation solution not only addresses the pressing issues surrounding prior authorization but also paves the way for more efficient, patient-centered care in the healthcare landscape.