Prior authorization in healthcare requires providers to secure approval from insurance payers before they can see patients. While this process is meant to control costs and verify medical necessity, it often leads to significant delays in care. The traditional manual approach is labor-intensive, necessitating the verification of patient insurance details, submission of requests, and follow-up with insurers. If a request is denied, providers must prepare additional documentation or appeal letters, which complicates the process further.
The complexities of the current system have serious repercussions. Rising operational expenses have compelled 35% of providers to hire additional staff just to handle prior authorizations, which can cost around $11 per request. Almost 93% of physicians report feeling overwhelmed by the administrative demands, and delays can double the time required for patients to access care, posing substantial health risks.
In contrast, prior authorization process automation systems greatly improve efficiency. These solutions can quickly gather necessary patient data, validate it, and prepare requests in a fraction of the time. They also automatically update medical records and monitor the status of requests, streamlining the entire workflow.
Orbit is a notable company in this space that offers groundbreaking solutions to the manual authorization system. Its AI-driven automation system has proven highly effective, saving providers around 60% on costs and generating approximately $449 million in savings across the U.S. healthcare sector. By optimizing workflows, Orbit reduces turnaround times by 55%, enabling staff to reclaim nearly 12 hours each week, ultimately fostering a more efficient and patient-centered healthcare experience.
Source: Orbit Healthcare