Award-winning collaboration resulted in rules-based automation of authorization requirements and determination.
Eden Prairie, Minnesota (May 20, 2023) — Itiliti Health was named a co-recipient of the KLAS Payer/Provider Points of Light Award, in collaboration with Availity to introduce efficiencies and automation in authorization determination. Itiliti Health’s best-in-class technology accelerates communication between payers and providers so the right medical policies are applied and the right procedures are authorized quickly, securely and cost-effectively.
The KLAS Points of Light Award celebrates success stories from payers, providers and healthcare technology companies that work collaboratively to solve administrative and clinical challenges. The goal of this collaboration was to eliminate—or significantly diminish—abrasion points in the authorization process, particularly when determining if an authorization is required for a care service.
According to Blue Cross Minnesota, nearly 40% of providers’ calls into the health plan’s call center related to whether an authorization was needed. The health plan estimated that the resources required for each call to handle each request cost between $5 and $7, and up to $13 to $15 for requests via fax.
To create a more automated, self-service solution for providers to quickly establish if an authorization was required, Blue Cross Minnesota utilized Availity’s authorization determination app—Is Auth Required. The app linked to Itiliti Health’s PA Checkpoint™, which is used by the health plan to create and manage a database of the health plan’s authorizations rules.
“We’re proud of the results this collaboration has produced for Blue Cross Blue Shield Minnesota,” said Michael Lunzer, CEO and Co-Founder of Itiliti Health. “This KLAS recognition demonstrates the ability for technology developers, payers and providers to come together to solve costly and manually driven administrative burdens.”
Together, these apps allowed the health plan’s provider network to check if an authorization was required before initiating a request. Providers receive real-time approval messages within their existing workflow. If an authorization is required and pends for review, a provider can electronically attach the required medical record.
According to the KLAS case study, Blue Cross Minnesota realized several benefits of this collaboration, including:
- $3.9 Million in estimated savings over three years across the health plan’s entire provider network.
- Increased portal use to 70%, eliminating the faxing option for local providers.
- Decrease in call volume – call volume for authorization requests dropped to 50 a month from 200 a month after tool was implemented.
- Positive provider feedback – the app is utilized about 100,000 times a month across the health plan’s provider network and in a recent provider survey, 77% of respondents indicated they found the look up tool very or extremely helpful.
About Itiliti Health
Itiliti Health’s mission is to reduce the cost of care by enabling efficient, real-time collaboration between payers and providers that eliminates wasteful administrative expense. Their initial solutions address the need to modernize the processes and management of prior authorizations for payers. The result is an improvement in patient care and significant reduction in administrative cost. For more information, please visit itilitihealth.com or contact Itiliti Health. You can also follow them on LinkedIn.