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.
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
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
Benefits/Results
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
