As the American Medical Association puts it, prior authorization creates “a huge administrative burden” for healthcare providers that often delays patient care. Despite this, reports suggest prior authorizations are increasingly common – and are increasingly leading to problems.

The good news is: Prior authorization automation – especially in patient access programs – can be a solution. While such automation enables healthcare providers to take responsibilities off their plates after a prior authorization is submitted, it can actually accomplish more than that.

Below, you’ll find five of the top reasons to consider prior authorization automation with AI, which is improving the status quo – for both patients and healthcare providers.

Stay current with changing rules 

There are thousands of payors and thousands of health plans – and rules and requirements for both are constantly changing. Add to that the fact that there aren’t many industry-wide standards for payors, and it’s easy to understand the challenge presented to busy healthcare professionals seeking information regarding patients’ prior authorization statuses. 

Imagine you’re an administrator in a physician’s office tasked with confirming  a patient is clear to go on a specialty medication. It can be both confusing and time-consuming to determine the steps to take and to acquire all necessary documentation to prevent the claim cannot be denied. Even with existing electronic prior authorization (ePA) solutions, and public websites, you might still need to make a call to a payor to confirm if a prior authorization is required. 

Because our AI is always learning, automating prior authorization follow-up tasks can help ensure you have up-to-date information about the latest payor rules, the status of a prior authorization, and any actions that must be taken should a patient’s prior auth be denied. In effect, the information you’re getting via prior authorization call automation is the exact information you’d be getting if you were on the call yourself.

Prevent delays to care

It can take anywhere from 24 hours to multiple weeks for the outcome of a prior authorization to be determined. If a healthcare provider’s staff has to make multiple calls to a payor (which is frequently the case) or a mistake occurs along the way, turnaround time can drag out. 

Conversely, prior authorization automation can leverage standardized call flows and, ideally, a wealth of data to collect required information in advance of treatment. This eliminates the need for multiple manual calls and ensures the correct information is acquired the first time, streamlining patient time to therapy.

Save time for healthcare professionals

Speaking of time: It’s in short supply. The amount of administrative work that must be completed before a patient can receive treatment has increased … but the time afforded to healthcare administrators to complete it has not. That’s one of many factors contributing to healthcare worker burnout, but it’s also something prior authorization automation can help ease.

Prior authorization automation enables providers to offload work once a prior auth has been submitted. At Infinitus, our AI digital assistant takes the reins as soon as the submission is complete. That means you can gather prior authorization requirements or status, as well as details and updates, without spending time on the phone with a payor.

Reduce errors (and denied claims)

There are multiple steps along the way where errors could be introduced into the prior authorization process – and even the most minor mistake can lead to a wrongful claim denial. An administrator tasked with researching an insurance plan’s prior authorization requirements might get them wrong, for example, or might write down the wrong information when calling a payor agent. 

When leveraging AI-powered automation, however, those errors can be reduced. The right automation solution will know how to acquire the appropriate information from payors, and won’t be subject to human error. Even the most experienced agents are still operating based on their own experience. At Infinitus, for example, our customers see an average improvement in data accuracy of 10% after implementing our solution – in great part because of our experience completing over a million calls.

Provide a better patient experience

According to an AMA study, the “costly administrative burden [of prior authorizations] pulls resources from direct patient care, as medical practices complete an average of 45 prior authorizations per physician, per week, which consume the equivalent of almost two business days (14 hours) of physician and staff time.”

By taking much of the prior authorization work off the plate of healthcare workers, they’re freed up to spend more time in clinical interactions, focused on helping patients – very likely the reason they entered the field in the first place.

Why automate prior authorization follow up tasks with Infinitus?

Infinitus is an enterprise AI application for healthcare, and the only solution to automate prior authorization call tasks. Our AI learns from every call made by our digital assistant, which itself relies on a vast pool of knowledge gained from having made over a million calls. This has given us unique insight into the patterns and best practices in exchanging data between healthcare companies – even when the data that must be communicated is nuanced.

Our prior authorization automation enables healthcare providers to offload prior auth follow-up tasks, including requirements and status, as well as details and updates for specialty medications, procedures, and diagnostic tests. That empowers workers to spend more time on more important, patient-facing work.

To learn more about how Infinitus can help ease the burden of prior authorizations, listen to a demo call or contact us today.