At Itiliti Health, we use cutting edge technology and analytics combined with our deep understanding of user experience to offer a solution that eases administrative friction and workflow for plan administrators and physicians. With PA Checkpoint in place, providers can receive an immediate answer on whether a PA submission is required for a procedure.

Prior authorization exists for good reason. It helps to ensure that medical procedures being suggested are appropriate for the condition in question and confirm that providers will be covered for the request within the health payers plan. 

However, though the need for prior authorization may be straightforward, the delivery process is far from it. Over *60% of doctors claim it’s difficult to distinguish whether medications or services require prior authorization. And, although electronic health records (EHRs) exist, most physicians still rely on telephone or faxing in order to get a definite answer on whether a PA request is required or not. 

In a world where it’s possible to order lunch to your house in just a few taps of an app or search hotel prices on the other side of the world in real-time, our medical communities still rely on communication methodologies from the last century. Given this fact, it comes as no surprise that 88% doctors report that PA processes can interfere with continuity of care for patients. 

To avoid further healthcare inefficiencies and impact on patient care a new era of communication and collaboration is required between payers and providers. 

Let’s explore three key ways that technology can improve the payer and provider relationship: 

1. Providing a real-time response for PA enquiries 

This helps to ensure that patients don’t suffer from additional delays and lets doctors and their administrative teams get back to the task of serving patients.  Streamlining the Prior Authorization Process 

With a solution such as PA Checkpoint providers can determine the need for prior authorization in real time, reducing administrative burden. By eliminating the need for providers to call or fax, call centers can expect to receive double digit reductions in call volume, call duration and PA submissions. 

This means the payers’ call centers will benefit from a significant boost in efficiency – time and resources that can be better utilized dealing with other provider inquiries that don’t have a simple Y/N answer. All in all, PA Checkpoint is positioned to benefit providers, payers and patients due to the improved service delivery of health plans.

PA Checkpoint is the only solution that creates a provider facing, searchable medical policy database organized by CPT code. This allows secure, reliable real time determination of the need for prior authorization by provider staff and non-clinicians to utilize.

2. Advanced Database Managment

The intuitive User Interface (UI) enables easy and timely implementation or revision of specific policies by the payer. The product customization capabilities allow for flexible policies to be implemented by LOB or employer and the advanced database structure can receive mass uploading of policy requirements to reduce implementation workload. Again, significant efficiency gains such as these will benefit all parties, as valuable time is freed-up to focus on the important task of delivering the best quality care to patients nationwide.

3. Is it time to change your PA processes?

The implementation of new technology enables payers and providers to benefit from automated processes, real-time access to information within the patient care pathway and advanced database management capabilities that will turn the PA process from a point of friction into a standard part of the day. 

Reach out to our team today to book a demo and learn more about the efficiency gains PA Checkpoint can offer: https://itilitihealth.com/contact/

* Source: https://www.ama-assn.org/system/files/prior-authorization-reform-progress-update.pdf 

About Itiliti Health

Itiliti Health is on a mission to extend its product offering further using medical policy transparency and AI to deliver widely available, automated prior authorizations to the US healthcare system. This will save costs for both insurers and providers and deliver faster, higher quality care to consumers.

Itiliti Health provides payer solutions that streamline the prior authorization process. PA Checkpoint^TM was conceived in collaboration with Blue Cross Blue Shield of Minnesota and assists health plans to reduce costs by eliminating hundreds of thousands of unnecessary prior authorization related telephone calls and submissions. PA Complete^TM will ultimately automate prior authorization adjudication using AI and NLP. Itiliti Health is an experienced health plan focused partner and has a robust roadmap to address several additional payer challenges for interoperability and transparency. For more information, visit www.itilitihealth.com.