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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 – is designed to enable real time adjudication based on your complex medical guidelines and may be integrated directly into your existing utilization management systems.

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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.

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Smart, Innovative Technology

Use natural language processing (NLP) and machine learning (ML) to unlock unstructured data, representing 65 percent 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.

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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 RequestPayer’s Utilization Management (UM) System receives a PA case from the provider and connects with Stanson for evaluation.
  2. Extract DataStanson extracts patient facts from the submitted case using NLP and ML.
  3. Evaluate Medical NecessityStanson evaluates the submitted case against payer policy.
  4. Automate AdjudicationStanson 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.

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This is an advertisement for services. Results and savings will vary based on individual circumstances. Embedded links are accurate at the time of publication
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1 2018 AMA Prior Authorization Physician Survey. February 2018. American Medical Association, Chicago, IL. Available at: https://www.ama-assn.org/system/files/2019-02/prior-auth-2018.pdf Accessed June 3, 2019.

2 Morra D, Nicholson S, Levinson W, et al. US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers. Health Affairs 2011 30:8, 1443-1450. Available at: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2010.0893 Accessed May 20, 2019.

3 Meystre SM, Lovis C, Bürkle T, Tognola G, Budrionis A, Lehmann CU. Clinical Data Reuse or Secondary Use: Current Status & Potential Future Progress. Yearb Med Inform. 2017;26(1):38–52. doi:10.15265/IY-2017-007