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
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
