Calculate Prior Auth Savings Across Your Network
Prior Authorization (PA) burdens continue to have a negative impact on patients, providers and payers. In an attempt to address this impact, CMS is mandating the use of technology to improve the flow of data among payers and providers. However, it’s not enough to just implement the APIs required by CMS, the PA workflow needs to be reinvented leveraging modern technology to eliminate the administrative burden and streamline the decision process.
The PA Calculator below estimates your network’s potential savings realized from leveraging Smile’s FHIR®-native solutions for your PA and compliance needs.
| Most physicians report spending over 12 hours a week solely on Prior Auth, causing significant burnout. | More than 78% of patients abandon their treatment leading to delays in care and later intensive re-hospitilization. | Only 15% of physicians indicated that Healthcare Plans can appropriately make Prior Auth determinations and assessments. |
One of the reasons for PA burden is the complexity is that there are inconsistencies across Payer (different rules and requirements for different payers) that often evolve without providers knowing. 33% of PA in the US is still manual (delivered through phone or fax). Another 39% is partially electronic, which adds to the complexity, burden of effort. and does not allow transparency through the decision and appeal process.
It is estimated that Payers spend about $26B annually on manual administrative processes like PA.
US Payers today require a solution that reduces burdens, risks, delays, burnout, adverse events, and over-utilization of the entire health ecosystem. A well implemented, strategic solution will reduce administrative costs for both payers and providers, significantly improving payer-provider relationships and enhancing patient care and satisfaction.
Payer-Provider Relationship
For Payers, each manual PA review takes a lot of effort and time. In certain cases the tooling required to run an analysis of deep clinical specialities are less accurate and cause further delays. This leads to chronic frustration for providers who, on average, spend up to 74 mins per PA request.
One of the ways to transform the burdens of PA into collaboration and a friction-less experience between payer and providers is re-architecting and automating certain phases of PA.
The Solution: Smile Prior Authorization
For US Payers, implementing a future-proofed solution for PA that reduces burdens, risks, delays and costs for the entire health ecosystem is essential.
The upcoming CMS-0057-F Rule has complexed and nuanced PA requirements, including integrating the APIs, adherent to the USCDI (United States Core Data for Interoperability) standard for data classes and elements, as well as recommended Da Vinci IGs (Implementation Guides).
Smile Digital Health is working with over 20 innovative payers who are investing in our solution that meets all the requirements of CMS-0057-F, while automating PA. This allows payers to transform their business operations, while also realizing network-wide savings that improve payer-provider relationships.
But don’t take our word for it. Calculate your payer-network savings below.
Enter in Your Member-related Information
Additional benefits include:
- Sustainable improvement of payer-provider relationships
- Enhances patient/ member satisfaction and a potential increase in STAR ratings
- Enhanced Clinical Decision Support (CDS) and Coverage Requirements Discovery (CRD) utilizing reusable clinical logic that supports quality measures.
To get a better understanding of how these savings work for you and your provider networks, schedule a call with us.