Prior Auth Software Case Study:
Discover How This Health Plan Saw a First Year IRR of 199%

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, utilizing various systems to retrieve decision information and to distribute results across the organization.

The Challenge/Business Need:

• Complete documentation
• Maintain CMS compliance
• Ability to handle new business without adding staff
• Complex operational reporting
• Enterprise dissemination of PA data
• Support a large, specialized work force

Solutions Provided:

• PAHub Prior Auth Software
• Enterprise CS system integration
• Full documentation & audit support
• Custom sFTP reporting support
• Custom work queues by department
• Peer to peer notification capabilities