Tips to Ease the Burden of Prior Authorization: for Patients, Providers and Payers

By Christina Perkins, Vice President of Business Insights at NantHealth

The COVID-19 pandemic has stretched healthcare systems, forcing them to care for more patients with reduced staff.  One immediate action healthcare systems can take to increase patient care is to streamline or eliminate time-consuming administrative work.

Prior authorizations put a tremendous burden on providers and payers. Physicians average 29.1 prior authorizations per week, and their staff spends about 14.6 hours processing them.  According to an American Medical Association survey, medical authorizations are barriers to effective patient care, contributing to delays in 92 percent of cases.

Prior authorizations are confusing and complicated for all stakeholders, but they are also among the highest cost payer/provider transactions. Here are four key ways payers and providers can work together to improve the prior authorization process:

  1. Turn to technology for transparency and efficiency. Providers struggle with paperwork overload. This is a major industry issue according to the CAQH Index, finding that out of the $42 billion spent annually conducting administrative transactions, 48% can be saved by transitioning to fully electronic transactions. Solutions like NantHealth’s Eviti Connect,and NaviNet OpenAuthorizations allow payers to offer a simple, electronic process for providers.
  2. Improve data quality. Prior authorizations require multiple interactions between providers and health plans, taking time and adding expenses. Providers also worry supplemental documentation could get lost or delayed. Bridging this gap with technology speeds the process, simplifies the workflow, and reduces unnecessary treatments and costs.
  3. Alleviate the supplemental documentation guessing game. Industrywide, nearly every authorization requires supplemental documentation. NaviNet provides clarity about what records are needed. With the ability to attach electronic documents to a prior authorization request, payers receive everything they need to make a faster decision.
  4. Speed care in service of patients. An integrated solution that isn’t dependent on time zones and reaching people by telephone saves time. Codified rules can be applied automatically, thereby adding value across the entire prior authorization process to expedite patient care.

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