Prior authorization is a process unique to the healthcare field. This process requires a healthcare provider to verify that a patient’s insurance covers whatever treatment or service they need before it is done. Prior authorization can help save a patient money by reducing healthcare costs through their insurance coverage.

But the need for healthcare workers to check a patient’s prior authorization is becoming a burden for them, and for the patients too. The American Medical Association reports that over a third of physicians say that prior authorization led to hospitalizations or death for patients. Over 90% of physicians report that there are significant delays in the processing of patients’ prior authorization, and healthcare providers spend nearly two business days processing only prior authorizations.

It is clear that healthcare workers and patients alike would benefit from the automation of prior authorization. Healthcare workers would be able to spend more time focusing on patients and patients would receive their treatments quicker. But what would prior authorization automation look like?

Automating Prior Authorization

Prior authorization involves checking specific insurance information, and this kind of task is what robotic process automation (RPA) excels at completing. The bots that are used for RPA can be taught to look for certain kinds of information, allowing them to interact with different systems to review and extract the information that is needed. This is the same information that a human healthcare worker would have at one point checked on their own. With RPA, healthcare workers would no longer need to check insurance data because the bots can be trained to extract that information on their own and check it through an insurer system. Removing humans from manually checking prior authorization would result in fewer insurance errors on the healthcare provider’s part.

RPA bots are quicker and less expensive than other solutions for prior authorization because they do not require custom software development. Combining them with different layers of intelligent automation AI can help the RPA bots identify the correct information across a wide variety of forms too.

Automating prior authorization can also allow different healthcare providers to check a patient’s insurance benefits from one system. Currently, there is no aggregator available that has all the potential insurance companies a patient could use. Even if there was an aggregator available, prior authorization checks would have to go through multiple systems that extract and review information. All of these systems would benefit from automation. RPA bots could be trained to interact with the insurance company and any other system it has to pass through to speed up the prior authorization process.

Published On: June 22nd, 2022 / Categories: Automation, Healthcare, Insurance /

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