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.

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

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