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

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.

Prior Authorizations Accelerated by AI and Automation

Our cloud-based, AI-powered prior authorization software provides a complete patient access solution for healthcare providers by leveraging the latest machine learning, artificial intelligence and automation technology with exception handling by our experienced billing specialists.

Requests requiring a prior authorization are initiated electronically to the appropriate payer. Complex requests and exceptions are handled by our team of certified specialists to provide you with complete coverage of your prior authorization claim.

Status notifications are communicated in real-time through automated follow-ups by robotic process automation (RPA). Our RPA bots repeatedly check requests under review for status change updates.

We provide you with complete coverage of your prior authorization requests with a 98+% accuracy and 99.5% adherence to turnaround times. No more auth requests getting kicked back to you due to lack of information. We take care of it for you.

Provider Integration

Submit and update your prior authorization requests directly from your local EHR/EMR using either an API or HL7 based bi-directional integration.

Authorization Determination Engine

Determine if your request requires a prior authorization using the Authorization Determination Engine, built using machine learning.

Unified Workflow Experience

Perform all prior authorization related functions on a unified web portal, built to offer you an intuitive and seamless experience.

Automated Authorization Follow-up

Keep up with the status of an initiated prior authorization claim using automated authorization follow-up.

Analytics and Reporting

Obtain full transparency into your prior authorization process using detailed and robust analytics and reporting.

Alerts and Notifications

Receive constant alerts and notifications pertaining your prior authorization claim, which includes all updates and payer communications