What You Should Know: - Prior authorization is mandated by payers to ensure that certain clinical procedures and medications being ordered are necessary. To alleviate the heavy administrative burden this requirement causes, healthcare organizations have adopted automated prior authorization solutions. - For this report, KLAS interviewed 30 respondents from 26 unique organizations to understand their experiences using these solutions and what outcomes they have seen. Understanding
Read More
Automated Prior Authorizations
HLTH22 Day 3 News Summary
DispatchHealth Raises $330M for Hospital-at-Home Care DispatchHealth, a provider of in-home medical care raises $330M led by Optum Ventures with support from current investors such as Humana (NYSE: HUM), Oak HC/FT, Echo Health Ventures and Questa Capital. New investors included Adams Street Partners, the Olayan Group, Silicon Valley Bank, Pegasus Tech Ventures and Blue Shield of California. Patients and their care partners can request DispatchHealth medical care via phone, mobile app, or
Read More
Edifecs Partners with Empowered-Home to Deliver Automated Prior Authorizations
What You Should Know: - Edifecs and Empowered-Home announced a partnership to provide automated prior authorizations to medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home health care agencies. - The Edifecs prior authorization solution combined with the clinical decision support system of patient management software company, Privis Health, forms the backbone of Empowered-Home’s ecosystem. Empowered-Home is
Read More
GuideWell Becomes First U.S. Payer to Automate Prior Authorizations
What You Should Know: - GuideWell, one of the 10 largest health insurance providers in the U.S., became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews from Olive, resulting in faster care for patients — up to 10 days faster — and greater provider satisfaction. - After launching a pilot with Olive in Florida, GuideWell saw its time to decision reduced by 10 days when immediate responses were available, decreased unnecessary prior
Read More
Cohere Health, Humana Expand Partnership to Transform Prior Authorization Process
What You Should Know: - Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere's digital prior authorization platform for musculoskeletal (MSK) services, based on the success of its initial implementation. - After rolling out the platform across 12 states in January 2021, Humana has made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider
Read More
XIFIN Expands Patient and Physician Engagement Capabilities
XIFIN announced the expansion of its portfolio of physician and patient engagement solutions with integrated patient responsibility estimation and automated prior authorization capabilities, enabling diagnostic providers to improve their patient experience and physician satisfaction. The new capabilities include a strategic partnership with Glidian that integrates automated prior authorization capabilities with XIFIN’s revenue cycle management and laboratory information system solutions, XIFIN
Read More
Inova Personalized Health Accelerator Invests in Prior Authorization Platform, CoverMyTest
Inova Personalized Health Accelerator (IPHA), an unique program providing health IT entrepreneurs with C-suite coaches, early-stage capital and strategic partners, today announced it has invested in health IT startup CoverMyTest. The New York-based startup partners with labs to optimize and automate prior authorization (PAs) workflows.CoverMyTest is the only PA service provider solely focused on assisting laboratories offering genetic and genomic testing. This PA software comes at a critical
Read More
3 Key Areas An Automated Prior Authorization Solution Must Address
Editor's Note: Co-written by Scott Herbst, Senior Vice President and General Manager of Provider Solutions and Ryan Miller, Senior Vice President of Strategy & Corporate Development at Availity.Prior authorizations may be as popular among providers as ants at a picnic, but they have become a common and necessary part of the reimbursement process. As a result, being able to manage prior authorizations efficiently is critical to maintaining a healthy revenue cycle and avoiding issues such as
Read More
