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.

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.