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.

Prior Authorization Automation

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


  • 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

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