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Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
Differentiators
Keywords
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Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Use cases
EHR integrations
Client types
Differentiators
Keywords
Media
Company details

Categories

Solutions

Description

Product Description:
Obtaining pre-authorizations without delay is essential to both preventing unnecessary delays in care and ensuring accurate reimbursement for services provided. But there are multiple challenges to administering an efficient, effective pre-authorization program, including: • Recruiting and retaining staff who have both clinical and revenue cycle expertise • Dedicating resources to stay up to date on complex, evolving guidelines and payer-specific requirements, and to manage payer responses • Lack of a consistent, technology-enabled workflow An Efficient Solution: Our Authorization Management Services staff manages pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission. Our solution includes: • Authorization Experience and Expertise – Our services are provided by clinicians (nurses or allied health depending on client need) who have specialized education in authorization requirements and commercial screening tools. Our team members average more than five years of clinical and authorization experience, stay up to date with training and compliance, and are dedicated to helping ensure that no part of your authorization request slips through the cracks. • A Centralized and Streamlined Technology Process – Our team leverages a centralized system to accelerate payer response, with processes that are efficient and repeatable. We incorporate robotic-process automation to assist with account statuses and system updates. • Thorough Authorization Clinical Review – Our team reviews each medical record, focusing on payer-specific requirements and obtaining authorization for services scheduled or rendered. We stay abreast of changes to Medicare, Medicaid, and commercial payer guidelines. • A Focus on Reducing Authorization-Related Denials – We take a holistic approach to authorization, which includes working auth-related denials. We review denied admissions, days, and services, and complete all necessary steps for reconsideration and appeal requests. Our denial workflow is customized so that we can pair expertise to the type of denial; for example, leveraging technical versus clinical staff depending on the reason for denial. • Detailed Performance Reporting – We provide detailed performance reporting that includes a month-over-month view of account activity including: √ current status √ completion percentages √ approval percentages
About Change Healthcare:
Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.
Product Description:
There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble: - Automatically verifies, initiates, statuses and retrieves comprehensive authorization details - Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes - Integrates directly with all major HIS and PM systems - Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity - Adapts to constantly shifting payer rules and requirements - Was built and is maintained by our in-house team of experts
About Waystar:

Waystar delivers innovative technology that simplifies and unifies healthcare payments. The company’s cloud-based platform helps healthcare providers across all care settings streamline workflows, improve financial performance and bring more transparency to the patient financial experience. Waystar solutions have been named Best in KLAS or Category Leader by KLAS Research 16 times (across multiple product categories) and earned multiple #1 rankings from Black Book. The Waystar platform is used by more than half a million providers, 1,000 health systems and hospitals, and 5,000 payers and health plans—and integrates with all major hospital information and practice management systems. On an annual basis, Waystar’s AI-powered solutions process $5B in patient payments, generate $4B in out-of-pocket estimates and process claims representing approximately 40% of the U.S. patient population. For more information, visit www.waystar.com.

Compatibility level

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Clients

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Use Cases

Description:

None provided

Pediatric use cases:

None provided

Users:

None provided

Description:

With over 300+ payers and a broad array of deployable service lines and patient types, we provide a full cycle automation solution for prior authorization: from pre-scheduled prior auth submission, status checking and denial prevention worklist alerts, as well as medical necessity verification and notification of admission.

Pediatric use cases:

None provided

Users:

Pre-service financial clearance teams, auth cert teams, any prior authorization staff doing medical necessity as well as authorization for services at acute care facilities or OP areas.

EHR Integrations

Integrations:

None provided

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

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Hardware Compatibility:

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Integrations:

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EMR Integration & Relevant Hardware:

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EMRs Supported:

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Hardware Compatibility:

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Client Types

Differentiators

Differentiators vs EHR Functionality:

None provided

Differentiators vs Competitors:

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Differentiators vs EHR Functionality:
Many hospitals, health systems, and IDNs have invested in billion dollar EMR/EMRs which are an extraordinary vehicle for clinical and billing functions -- but lack the ability to elevate automation in key business areas such as prior authorization. This is due to their lack of payer connections and the absence of advanced intelligent software. Together, Waystar brings the intelligence that powers today's EMR/EHR platforms and automation efforts.
Differentiators vs Competitors:
With nearly a decade in the business of automating prior authorizations, we are known for our internal expertise when it comes to payers, process change, and technology. We believe pushing the envelope in know-how across all 3 is what gives our clients the edge on automation. With more payer connections, more relationships with payers, and greater flexibility in accessing payer data we can access the best and most timely data. We not only seamlessly integrate with EPIC but offer full-stack integration capabilities or a powerful stand-alone application -- all because each patient access team is different. And powered across our Hubble platform (a blend of RPA, machine learning, NLP, and advanced auth rules) we are well positioned to power your automated enterprise.

Keywords

Images

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Company Details

Founded in 2007

Founded in 2000

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