A fully automated, electronic prior authorization solution is here. No more faxes, no more endless phone calls, no more overwhelming stacks of paper. Through the power of advanced artificial intelligence, Olive has automated the entire prior auth process, including the hardest steps of handling medical necessity and clinical documents. One of healthcare’s biggest problems finally has a solution that turns this antiquated process into a fully electronic and automated workflow. So, how does Olive do it, and what does this mean for the healthcare industry?
Why healthcare needs an automated, electronic prior authorization solution
Prior authorizations are the most time-consuming and costly administrative process in healthcare. On average, a single manual prior authorization requires 21 minutes of provider staff time, and a single physician averages 37 prior auth requests per week1. That adds up. Financially, it’s estimated that fully electronic prior authorizations could save payers $99 million and providers $355 million each year2. It’s an outdated, burdensome process that is driving up the cost of care and contributing to healthcare workers’ burnout and frustration. Even worse, the inefficiencies in the current system are negatively impacting the patients, delaying much-needed care.
The industry knows that prior auths are a problem. Payers, providers and technology companies have been striving for an electronic system for years, but 89% of prior authorizations still involve faxes or phone calls. Why hasn’t this problem been adequately solved?
The answer is the technology. Prior authorizations are a multi-step process requiring data and information from disparate systems. Inconsistent standards and ever-changing rulesets have made many of these steps, such as medical necessity checks and gathering clinical documents, difficult to automate with traditional RPA software, the standard automation tool. RPA is limited; it works only under clearly defined rules for every possible step. Any interface update or minor change requires new coding, making it impossible to create and manage an RPA solution that works for the nuances and exceptions inherent in the prior auth process. That’s why all the other prior authorization softwares on the market are only point solutions, automating a small portion of the process, for example, eligibility checks.
Olive is different. Olive uses advanced artificial intelligence capabilities to automate the entire process, a true end-to-end prior authorization solution. With AI, providers and payers can transform the patient experience and prior authorization workflow, with benefits rippling through all of healthcare.
The benefits of fully automated prior authorizations
The clearest benefit of truly automated prior authorizations is the significant reduction in turnaround time. Currently, it can take up to two weeks to approve a prior authorization request. The volume of required prior authorizations continues to increase and has become one of the main drivers of delayed care. In fact, 91% of physicians have reported care delays due to prior authorizations. And these delays are costly for everyone involved.
For patients, it’s frustrating and confusing when a procedure or test can’t be scheduled. It can cause patients to look to competitive providers or even abandon treatment. For providers, the slow turnaround time makes it difficult to achieve optimal patient throughput and nearly impossible to fill last-minute cancellations. At its worst, it erodes the patient-provider relationship and can give competing facilities an edge. For payers, the manual process is expensive, time-consuming and leads to health plan dissatisfaction. In short, everyone loses – except competitors.
“Patients were wondering what was taking so long. Doctors, nurses and administrators became frustrated. Our referral sources began to ask if they should refer patients to other clinics.” – Becky Shields, clinic nurse at Watertown Regional Medical Center
Olive can change this. With automation, she can accelerate the prior authorization turnaround time by as much as 78%. Patients have a much smoother experience, and providers and payers achieve greater productivity and reduced administrative costs.
A second benefit of automation is error reduction. Whenever a human has to manually provide data, errors often occur. It may seem small, but when you consider the number of prior authorizations submitted and reviewed every single day by all the points of care across the country, these errors start to add up. When you eliminate simple errors, you reduce denials, reduce rework and end up saving a lot of money due to reduced write-offs. One Olive customer saw a 32% year-over-year reduction in write-offs across every department using Olive.
At the end of the day, however, the most important benefit of automated prior authorizations is the time it gives providers back to spend with patients. Current estimates show that physicians are spending an hour each day on prior authorizations and staff an additional 19 hours per week. It’s a drain on energy and resources, contributing to burnout and distracting from quality care. With Olive, physicians can easily initiate point-of-care prior auths, receive approvals faster and reduce staff time spent submitting and following up with payers. All the patients know is that they are getting quality, timely care and an accurate bill at the end of the day.
How Olive prior authorizations
Olive is a comprehensive prior authorization solution, leveraging artificial intelligence to automate the process and helping payers and providers take control and become leaders in their markets. Here’s how she works:
It starts at the point-of-care, when Olive receives an authorization request from the provider. Olive checks if a prior authorization is needed and updates the EHR accordingly. If it is determined that a prior auth is needed, Olive prepares and builds it with information directly from the EHR. Olive also retrieves rules from 40,000 national, regional and state payers to identify clinical requirements and documentation, and even helps submit the prior authorization request. From the payer side, Olive determines if medical necessity criteria have been met, making it easy for the authorization reviewer to approve or deny the request before moving on in their queue. For the provider, Olive continues to track all prior authorizations, make status checks, and even automatically send a first-pass appeal if an authorization is denied after service.
Olive is the only comprehensive prior authorization solution, making healthcare better for providers, payers and patients
This is what we mean by end-to-end prior authorization: a comprehensive approach to every step of the process to help prevent provider write-offs, improve insurance utilization management and accelerate patient care. Seamless EMR integration and proprietary connections to payers make Olive the best solution for prior authorizations available.
Learn more about prior authorization solution and how we’re helping payers and providers harness the power of AI.