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
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Complete documentation
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Faster processing (24-hour turn-around)
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Ability to handle new business
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Easier reporting to state agencies
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Share the information across the enterprise
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Support a dispersed work force
Solution Provided
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Paperless processing
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Full documentation and audit support
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Integrated faxing service
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Custom reporting support
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Custom work queues
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Web-based software support for dispersed work force
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Enterprise integration to share request status across the organization
Benefits/Results
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Volume doubled with an actual reduction in staff
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Processing speed increased more than 133%
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Paper case documentation eliminated
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State reporting prep time reduced by more than 50%
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100% compliance with state processing requirement using custom queues
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Customer Service access to request data via their standard system and process
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Staff access the system from multiple locations via the web
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