Most stakeholders in the group benefits industry now recognize that improving the prior authorization claims process is necessary, and increasingly payers agree.
There are several reasons to support change in the prior authorization claims process:
Technology is now available that provides an efficient electronic claims preparation and submission (ePA) solution for all prior authorization stakeholders, and it comes with several benefits:
There are other benefits to ePA, including:
The technology for a first generation agnostic electronic prior authorization solution (ePA) is available today.
Today’s ePA solution does not include claims criteria. It was developed with the ability for each payer to apply their own unique proprietary criteria for adjudicating prior authorization claims.
As a result these claims will be adjudicated manually in this first generation ePA solution. Second generation ePA will add algorithms based on each payers’ unique criteria, which will mean that there can be automation of some or most prior authorization claims based on each payers’ discretion.
For more information on this first generation ePA solution please contact firstname.lastname@example.org.