The Orthopedic Clinic and Florida’s leading health insurer reduce prior auth submission-to-decision time by 41%


Learn how The Orthopedic Clinic began receiving prior authorization decisions at the point of care.

76% time reduction from physician order to auth submission

56% of prior auths finalized without manual intervention

27% reduction in unnecessary prior authorization submissions

The challenge

A provider facing high admin burden from prior authorization

The Orthopedic Clinic (TOC) had a high volume of prior authorization requests, a lack of automation and limited staffing resources, which caused scheduling issues and delayed patient care. On top of that, tedious back-and-forth communications between TOC and their payer partners were causing friction. TOC needed to be more efficient with their prior authorization process to deliver an outstanding patient experience.

A payer partner tackles industry wide prior authorization complexities

For most of the industry, including Florida’s leading health insurer, the traditional prior authorization process is a time-consuming, expensive and dissatisfying process for providers, payers, and members. This innovative payer partner saw these challenges firsthand and was looking to improve these challenges that every payer experiences.

They had a vision to build a best-in-class, innovative and affordable UM model that moved away from the traditional way of doing things and drove outstanding member and provider experiences.

The solution

Reducing friction for payers and their provider network

With Olive, TOC and Florida’s leading health insurer were able to tackle these challenges, streamline the prior authorization process and reduce the administrative burden causing friction for providers and members. TOC leveraged Olive’s End-to-End Prior Authorization solution and shortened the time from a physician order to submitting a prior authorization request by 76%. Their payer partner implemented Olive’s Utilization Management solution and decreased their turnaround time from submission to decision by 41%.

Implementing AI and automation into the provider and payer workflow enables a direct-submit capability for the provider staff, streamlining the time it takes to submit a request.

“This new feature has made submitting cases to this payer so much easier. It reduces the time both when I’m submitting the authorization and retrieving the response. I wish all of my auths could be submitted this way!”

— Weslie Harden, Surgery Insurance Authorization Lead at The Orthopedic Clinic

Prior authorization decisions at the point of care

Olive now integrates with TOC’s EHR through the end-to-end prior auth solution and utilizes the payer partner’s business rules to determine immediately if a PA is required — and if not, Olive instantly notifies the provider to eliminate unnecessary delays in care and reduce the number of unnecessary prior authorizations going to the payer for review.

When a prior authorization is required, Olive intelligently generates real-time authorization recommendations based on the submitted clinical documentation, enabling TOC’s payer partner to deliver real-time prior authorization decisions at the point of care on 56% of requests in seconds without manual intervention — ultimately reducing the time to final decision by 48% across all patients with this health plan.

The results

Icon - Star with check
Created-to-submission cycle time fell by 76%, increasing staff efficiency and allowing providers to spend more time with patients
Icon - Double Arrows
41% decrease in submission-to-decision cycle time when submitting directly to the payer, reducing administrative burden and accelerating care delivery
side profile on a head
48% faster decisions with the payer using AI for prior authorization reviews, ensuring their members get the care they need, when they need it

“Olive has been an innovative partner, helping us take our prior authorization process to the next level by automating our workflow, increasing our patient throughput, reducing denials and having a great impact on our revenue.”

Shannon Stewartson

Chief Executive Officer at The Orthopedic Clinic

Shannon Stewartson headshot

Start your journey with a conversation

Talk to our team about your organization, and we’ll help you find the solutions that are right for you.