Automated Prior Authorizations for Payers

It’s no secret that current prior authorization (PA) processes are known for being labor intensive, time consuming and costly for the payer and the provider. Because of this, 75 percent of providers share that the PA process led to treatment abandonment, which negatively impacts value-based contract outcomes.1  With providers spending $82,975 on average annually to deal with the PA process, provider groups are now seeking greater value from payer contracts.2 The payer PA process may also impact the payer back office operations and Clinical Reviewers who spend large amounts of time reviewing authorization requests that require complex decision making before a provider is approved to deliver care.

Get Started With a Feasibility Assessment

Help reduce per member per month (PMPM) to as little as $0.10 with automated PAs in the back office.

Real-time Prior Authorizations in the Payer Back Office

Stanson’s automated PA solution – focused on the payer back office  designed to enable real-time adjudication based on your complex medical guidelines and may be integrated directly into your existing utilization management systems.

Annual Spend Reduction
Help reduce your PMPM to as little as $0.10 by automating PA decisions in the payer back office where many routine decisions can be made real-time. By delivering a decision quickly and efficiently, Clinical Reviewers can have more time to focus on the most complex cases.

Smart, Innovative Technology

Use natural language processing (NLP) and machine learning (ML) to unlock unstructured data, representing 65% of the chart3, and codifying complex medical guidelines to help get to decisions much faster, which may result in improved provider satisfaction and better patient care through lowered treatment abandonment.

Real-Time Approval
This is designed to validate a patient’s eligibility and clinical necessity and may minimize the need for human review, therefore helping to eliminate administrative waste for further clinical review and back office resources.

Automated Decisions in the Back Office

  1. Provider Submits PA Request
    Payer’s Utilization Management (UM) System receives a PA case from the provider and connects with Stanson for evaluation.
  2. Extract Data
    Stanson extracts patient facts from the submitted case using NLP and ML.
  3. Evaluate Medical Necessity
    Stanson evaluates the submitted case against payor policy.
  4. Automate Adjudication
    Stanson responds to UM with results of automated adjudication. If the system is confident in evaluation (i.e., for approvals and denials), the case may bypass human review. Otherwise, a UM specialist can evaluate results and interact with the solution as needed.

How do I get started?

  1. Start With a Feasibility Assessment
    Generate metrics for automated adjudication based on payor portal data. The goal is to understand, the following:
    1. How often can the solution auto-approve / deny a case?
    2. How many relevant facts can the solution automatically find?
  2. Provide Data
    Include 1 CPT code from a set of 60, including 10,000 charts to evaluate.
  3. Apply NLP and ML
    Use Natural Language Processing (NLP) and Machine Learning (ML) to analyze the data and offer analysis which can take 6-8 weeks.
  4. The Analysis
    Forecast cost savings based on projected auto-adjudication capabilities.
  5. Receive a Customized Plan
    Implement an automated adjudication solution supported by our Chief Technical Officer (CTO), including consultation time for integration.

Request a Customized ROI Analysis 

Resources

Smart, Fast, Efficient:
Introducing Seamless Patient Care

Prior Authorizations for Providers:
Learn About Stanson’s Solutions

This is an advertisement for services. Results and savings will vary based on individual circumstances. Embedded links are accurate at the time of publication