Automating and Optimizing Prior Authorizations the Right Way

Come learn how Atlantic Health System collaborated with technology leaders to achieve more than 60% automation in its prior authorization workflow for its Radiology services. This initiative used a combination of workflow optimization, process improvement, and intelligent automation while switching to the "schedule first, then authorize" approach for its radiology services. This initiative has resulted in an average reduction of 65% in processing time for prior authorizations while also eliminating the need to spend any time on services that do not require prior authorizations. The submission of prior authorizations to various payers was automated from the EHR that saved users from entering information that was already available. In addition, the automatic verification of prior authorization and updating that information accordingly in the EHR was done through intelligent automation, which eliminated the need to check payer portals every few hours or calling the payers. While automation was at the heart of this initiative, workflow optimizations for practice operations, physicians, and pre-services team was simultaneously done to make it efficient. Identification of services that required authorizations, development of a physicians peer-to-peer review process, creation of system tools to quickly identify services that required actions, were a few key ingredients to the success.