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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.
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 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.
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
- Provider Submits PA RequestPayer’s Utilization Management (UM) System receives a PA case from the provider and connects with Stanson for evaluation.
- Extract DataStanson extracts patient facts from the submitted case using NLP and ML.
- Evaluate Medical NecessityStanson evaluates the submitted case against payer policy.
- 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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Automating Prior Authorization at the Point of Care
Smart, Fast, Efficient:
Introducing Seamless Patient Care
Prior Authorizations for Providers:
Learn About Stanson’s Solutions