Prior authorization is essential in healthcare, requiring providers to seek approval from insurers for specific services. However, this process has become a major issue for many providers/patients, due to the delays in the overall care that customers receive. Surveys indicate that one in three providers face problems with the automation systems, often resulting in postponed appointments and treatments.
Traditionally, prior authorization is manual and cumbersome, involving time-consuming verification of patient insurance and medical histories. Each request can take 15-20 minutes, and if denied, it necessitates additional documentation and appeals, prolonging wait times. This inefficiency can cost up to $11 per authorization, leading many providers to hire dedicated staff for this task.
Patients suffer the consequences, with delays linked to increased hospitalization and life-threatening events. About 27% of physicians report frequent denials, and a majority lack the time to appeal negative decisions, perpetuating reliance on outdated methods.
Innovative solutions like Orbit’s AI-powered prior authorization process automation are emerging to streamline this process. Orbit has saved providers approximately 60% in costs and can process authorizations in as little as five minutes. The benefits include improved patient experience, reduced human error, significant cost savings, and reclaimed staff time, ultimately transforming prior authorization into a more efficient, patient-friendly system.
Source: Orbit Healthcare
