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. Determining whether a visit requires authorization means checking the specific payer's guidelines, and for Aetna-covered visits that lookup happens on the Aetna portal, one upcoming visit at a time. Until each is checked, the organization can't tell which visits need an authorization secured before service and which are clear.

Automation Solution

This automation checks Aetna guidelines to determine whether upcoming visits require authorization and updates the EMR tables with the authorization requirement.