Problem Statement

Authorizations must be handled within tight payer timeframes, and doing it manually is labor-intensive, so a missed or late authorization becomes an avoidable denial. When a patient's treatment or therapy plan changes, the account routes to a workqueue because the change may require a new or amended authorization. Central Authorization specialists open each account and compare what changed against what was authorized, roughly 504 accounts a month at about four minutes each. The volume is hard to staff, and a change missed before services are rendered turns into a denial or write-off on care already delivered.

Automation Solution

This automation reviews accounts routed for treatment or therapy plan changes, identifies where the change may trigger an authorization requirement, and flags those accounts for Central Authorization specialists to review.