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Prior Authorization

Prior Authorization

This category is a work in progress
Ability to obtain authorization from payers in advance of certain medical tests and procedures.

Prior Authorization: Products


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  • Covid-19
  • Pediatric
  • In Epic App Orchard
  • In Cerner App Gallery

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  • AMC
  • Pediatric Facilities
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15 products
Sort by:
Default
# of Clients- low to high
# of Clients- high to low
Alphabetical

Filter products


EMR compatibility

Product attributes
  • Covid-19
  • Pediatric
  • In Epic App Orchard
  • In Cerner App Gallery

Keywords

Solutions

Filter products by clients


Used by

EMR used

Organization size

Type
  • AMC
  • Pediatric Facilities
  • ACO
  • Rural Presence
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By PatientBond, Inc.

0 review

Notify patients of pre-auth status and co-payments due. Included with payment reminders.
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By R1 RCM

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These automated processes, which are part of the R1 Patient Experience, deliver accurate and complete authorizations directly within order and scheduling workflows to reduce administrative tasks, lower operational cost, streamline appropriate payment, and enhance the patient experience. With R1 Financial Clearance clients are able to get to “Schedule Ready” faster with sixty-seven percent of authorizations cleared within minutes and ninety-seven percent within 3 business days.
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EMRs supported

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SolutionsMedical Benefit Prior Authorization Tools, Referral Management Software Solutions, Patient Engagement and Support Platforms
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By Change Healthcare

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With InterQual Connect™, payers can easily automate all authorization requests, even those requiring medical review, within their existing systems. Providers receive quicker authorization approvals for most requests and payers only need to touch the exceptions that can’t be approved automatically—no more duplicative medical reviews or wasting precious staff time on routine authorizations. - InterQual Medical Review & Authorization: InterQual Connect is a flexible SaaS solution, integrated into payer and provider health information systems. It pairs the leading InterQual® Criteria, now available as a web service, with proven and secure connectivity. - A Unique Solution: The only integrated solution to enable full auto authorization, including medical review. - Uses Existing IT Infrastructure: No new hardware, software or IT staff required. - Easy to Implement: Time to value can be as little as 60 days when using a certified Change Healthcare Alliance Partner. - Provides Fast, Secure Connectivity: Uses the proven authorization gateway. - Keeps Users in Existing Workflows: Providers submit an authorization request, and payers receive the request and medical review from within their current UM/CM workflow. - Delivers Real-time InterQual Access: Just-in-time content from our cloud platform helps ensure you get the latest version, but you can choose when to make the switch. - Aligns with InterQual Hospitals: Payers benefit from the shared clinical language with thousands of InterQual hospitals plus a direct connection to those hospitals already on the InterQual Connect cloud. - Supports Payer/Provider Collaboration: Helps reduce the costs and hassle of prior authorization, while providing full transparency of payer criteria to providers. - Medical Review Service: Optimized for integration, this web service delivers seamless access to the InterQual medical review within your UM/CM system or payer’s provider portal. You get the same leading evidence-based InterQual Criteria combined with our modern, user-friendly interface. The SaaS platform helps you reduce your IT burden, providing realtime access to content. You receive software and content upgrades automatically without waiting for installation and validation, but still maintain control of when to switch to the newer content. You also gain the freedom to make the Medical Review Service available throughout a networked system, such as a multi-hospital and outpatient network or multi-location payer. The Medical Review Service works with any modern browser. - Secure Authorization Connectivity: Our cloud platform and authorization gateway enable the creation of a secure network of connected payers and providers by providing a common language, standard API protocols, access controls and routing rules. Providers transmit an authorization request, complete with an InterQual medical review, through the gateway directly to a payer. The payer system then applies business rules and the InterQual Criteria to this request, and instantly delivers the authorization status back through the gateway to the provider. The gateway has been deployed as part of our cloud solutions, and currently supports thousands of authorization transactions per week between connected payers and providers. It is optimized for our interoperable (XML) medical review format, and can also support the HIPAA X12 278 transaction standards.
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SolutionsMedical Benefit Prior Authorization Tools, Clinical Decision Support Systems
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By Change Healthcare

0 review

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
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SolutionsMedical Benefit Prior Authorization Tools, Revenue Cycle Management Services
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By Apprio

0 review

Healthcare Technology and Services
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EMRs supported

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SolutionsHealthcare & Technology Management Consultants, Community Health Worker Toolkit, Medical Benefit Prior Authorization Tools
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