Annual Peak Volume – Prior Authorization with PAHub

The Client

A health plan with both commercial and Medicare business with CMS regulatory requirements is using a semi-automated process to address prior authorization requests, accessing multiple systems to gather decision information and to disseminate results across the organization.

Prior Authorization Case Study

Challenge/Business Need

  • Complete process documentation

  • Maintain CMS compliance woth a 24/72-hour turn-around

  • Gain the 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


  • 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

Schedule Live Demo