Problem Statement

Authorizations must be resolved before service, and doing it manually is labor-intensive. For Radiology, each upcoming account has to be run through Real Time Eligibility, submitted to the payer for authorization, and then worked to resolution based on the payer's ANSI response, all before the patient is seen. Doing this manually across the authorization workqueues is slow and repetitive, and any account that doesn't get through the full cycle in time arrives at the visit without a secured authorization, converting directly into an avoidable denial.

Automation Solution

This automation works Radiology authorization workqueues in the EMR by running Real Time Eligibility (RTE) and submitting authorizations to payers, then resolves open issues based on the ANSI response prior to the patient visit.