Prior authorizations are a necessary but cumbersome part of the healthcare reimbursement process. They require significant time and resources to manage, often involving extensive paperwork and multiple, manual steps of approval. This tedious process can lead to delays in patient treatments, increased administrative burdens, and frustration among both healthcare providers and patients. Additionally, the complexity of prior authorizations can result in errors, lost requests, and inconsistent approval outcomes, further impeding the efficiency and effectiveness of care delivery.

If the problem is not addressed:

• Delayed Patient Treatments: Patients may experience postponements in receiving necessary medications, procedures, or specialist consultations, potentially worsening their health outcomes.

• Increased Administrative Burden: Healthcare staff spend excessive time managing prior authorizations, diverting their focus from patient care to paperwork.

• High Operational Costs: The labor-intensive nature of prior authorizations leads to increased administrative expenses and inefficiencies within the organization.

• Frustrated Patients and Providers: Prolonged approval times and complicated processes can lead to dissatisfaction and decreased trust in the healthcare system. That's not to mention the patient safety concerns.

• High Risk of Errors: Manual handling of prior authorizations increases the likelihood of mistakes, which can result in denied claims and the need for resubmissions.

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Calvient revolutionizes the prior authorization process by automating and integrating workflows directly within your EHR system. Our comprehensive platform includes task-driven workflows and centralized AI-powered fax communication to make back-and-forth interactions more efficient. Additionally, our platform handles the complexities of prior authorizations through several key functionalities:

• Eligibility Checking: Automatically verifies patient eligibility for treatments and medications, ensuring that requests meet necessary criteria before submission.
• ‍Status Reporting: Continuously monitors and updates the status of prior authorization requests, providing real-time insights into approval progress.
• ‍Accelerating Everywhere: Our AI-powered task lists ensure that no step in the prior authorization process is overlooked. By centralizing data from your EHR, we streamline communication and coordination across all departments involved in patient care.
• T-Shaped Automation: We implement targeted automation strategies that make processes 5-10% faster across the board. By focusing on your most significant payor and treatment combinations, we automate these areas extensively while working closely with your team to ensure seamless integration. This approach de-risks the transition to automation and facilitates the adoption of new tools, enhancing overall efficiency without overwhelming your staff.

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