Transforming the Prior Authorization Process to Improve Patient Care and the Financial Bottom Line

One of the biggest challenges in providing timely care to patients is prior authorizations. An American Medical Association (AMA) survey of 1,000 practicing physicians found that 86% described the administrative burden associated with prior authorization as “high or extremely high,” and 88% said the burden has gone up in the last five years. Estimates have prior authorizations increasing 14% year-over-year and up 27% from the index in 2016. As the burden of prior authorizations continues to increase, so does the need to manage the increasing challenges in delivering care.

To address the unsustainable challenges of prior authorizations, NEBH and its affiliate orthopedic practices, including BSSC, chose to implement technology that leverages A.I. to automate and standardize the prior authorization process, making it more reliable and scalable across their various locations.