Annual Peak Volume Handled with
70% of Previous Staffing Levels
PAHub™ Case Study: Prior Authorization Automation
The Client
A health plan with both commercial and Medicare business with CMS regulatory requirements is using a semi-automated process to address requests for authorizations, accessing multiple systems to gather decision information and to disseminate results across the organization.
Challenge/Business Need
- Complete process documentation
- Maintain CMS compliance (24/72-hour turn-around)
- Ability to handle new business without adding staff
- Complex Operational reporting
- Dissemination of PA data to enterprise systems
- Support a large but specialized work force
Solution Provided
- PAHub™ Prior Authorization solution
- Enterprise CS system integration
- Full documentation & audit support
- Custom FTP reporting support
- Custom work queues by department
- Peer to Peer Notification capabilities
- Pre-Decision Notification capabilities
Benefits/Results
- Annual peak volume handled with 70% of previous staffing levels
- First year IRR of 199%
- Customer service integrated PA Data enables single access point for answering questions
- Easier compliance with CMS processing requirements using custom queues/alerts
- Enterprise operational reporting able to generate management information using a level of detail not previously available
Learn more about PAHub™ software or contact us to discuss how we can help you.
Prior Authorization
Simplify Prior Authorization management of Prescription Drugs, Medical Services and Durable Medical Equipment with our easy-to-use web-based solution.
Physician Portal
Seamlessly integrates with our Prior Authorization software to initiate authorization requests, renewals and appeals, allow coverage criteria questions to be answered and check previous requests.
ePrescribing
Use our web-based ePrescribing software solution for point-of-care electronic Prior Authorizations for drugs, medical procedures, lab tests and DME.
