Prior Authorization

The Top Digital Prior Authorization Companies Report is intended to provide healthcare leaders with a broad view of the prior authorization process and showcase standout companies and solutions with proven market traction. Users can view quick summaries to help them identify which solutions might meet their needs and visit AVIA Connect to access detailed profiles and verified client lists, compare solutions, and generate Match Scores to narrow their selections.

The Top Patient Billing and Payments Companies Report is intended to provide healthcare leaders with a broad view of patient billing and payment and showcase standout companies and solutions with proven market traction. Users can view quick summaries to help them identify which solutions might meet their needs and visit AVIA Connect to access detailed profiles and verified client lists, compare solutions, and generate Match Scores to narrow their selections.

AVIA Marketplace's Top Prior Authorization Companies Why prior authorization matters What leading solutions offer AVIA Marketplace’s top prior authorization companies

AVIA Marketplace's Top Patient Billing and Payment Companies Why patient billing and payment matters What leading solutions offer AVIA Marketplace’s top patient billing and payment companies

Patient billing and payment are a patient’s ability to access, understand, and complete payment for healthcare services.

More than ever, health systems need to adopt a data-driven approach to patient payments. Patients payments account for up to 30 percent of hospital revenues, but collecting from patients is often much harder than obtaining reimbursements from payers due to complexity, regulation, and patient means. Sift Healthcare equips health systems with an integrated data-driven toolset to drive patient financial engagement, which allows health systems to: Pre-clear patients upfront Get more patients on payment plans, earlier Execute omnichannel contact across the entirety of the patient journey, so the right patients receive the right messages through the right channels Help patients commit to meeting their financial obligations before service Utilize an integrated view of insurance-patient responsibility to present and early and accurate summary of patient responsibility and optimize account resolution

Prior authorization is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.

With its end-to-end automation platform VALER, Voluware offers a unified solution for prior authorizations, referrals management, and eligibility and coverage. VALER fully automates prior authorization submissions and includes a comprehensive form library and real-time payer information and status monitoring. The cloud-based solution covers all service types, including professional, facility, technical, pharmacy, and DME authorization workflows, and creates a centralized communication hub to capture faxed medical necessity documentation and phone exchanges with payers.

Prior authorization, or PA, remains a massive administrative burden for health plans and their provider partners, and often delays patient care. It also represents an untapped opportunity to improve patient care journeys and enable more successful value-based care arrangements. The Cohere Unify™ solution suite automates prior authorization intake and decisioning to drive administrative efficiency, while adding clinical intelligence to speed and improve patient outcomes.

At Arrive Health, the patient-provider relationship is our true north. Our solutions leverage accurate, patient-specific data to help providers reach the best decisions with their patients. With real-time notifications for coverage restrictions and prior authorization details, as well as automatic initiation of the electronic prior authorization (ePA) process, providers can significantly reduce administrative burden and ensure transparent communication with patients and care teams. Our directly connected network combines real-time prescription benefit data (from payers and PBMs) with automated ePA capabilities to reduce provider burden, improve patient engagement, and speed time to therapy.

Change Healthcare is focused on enabling a better, more efficient healthcare system through the power of the Change Healthcare platform. Our goal is to help payers, providers, and consumers improve clinical and financial outcomes so that everyone in the healthcare system can thrive. Despite all the automation innovations that exist today, authorization automation remains a complex challenge. Although the industry has recognized some success, many gaps still exist that require costly human intervention. The manual nature of prior authorization, the need for clinical documentation, and payer connectivity are some of the challenges Change Healthcare is solving today.

Recently, I had the privilege of attending the AHA Rural Health Conference, a gathering that brings together healthcare professionals, administrators, and advocates from across the nation to address the unique challenges and opportunities within rural healthcare. The experience was not only enlightening but also deeply inspiring, highlighting the resilience, innovation, and dedication of those at the forefront of rural health. Reflecting on the conference, I’d like to share three key themes and takeaways that resonated with me, in the hope of offering some insights and encouragement to others navigating this vital field.