Volume Doubled – Prior Authorization Case Study

The Client

A health plan specializing in State Medicaid business with stringent regulatory requirements was using a manual process to address requests for authorizations, accessing multiple systems to gather decision information and to disseminate results across the organization.

Challenge/Business Need

• Complete documentation

• Faster processing (24-hour turn-around)

• Ability to handle new business

• Easier reporting to state agencies

• Share the information across the enterprise

• Support a dispersed work force

Solution Provided

• PAHub™ Prior Authorization solution

• Paperless processing

• Full documentation and audit support

• Integrated faxing service

• Custom reporting support

• Custom work queues

• Web-based software support for dispersed work force

• Enterprise integration to share request status across the organization

Benefits/Results

• Volume doubled with an actual reduction in staff

• Processing speed increased more than 133%

• Paper case documentation eliminated

• State reporting prep time reduced by more than 50%

• 100% compliance with state processing requirement using custom queues

• Customer Service access to request data via their standard system and process

• Staff access the system from multiple locations via the web