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@ShahidNShah
How Close are We to Making Prior Authorizations Digital and Automatic?
As the healthcare landscape evolves, the digital transformation of prior authorization is no longer a distant aspiration but an imminent reality – if we embrace it. Artificial Intelligence and automation are at the forefront of this shift, reshaping the entire revenue cycle management process. But there is still hesitation about AI and modern practices so there are hurdles.This is only one side of the coin, however. It’s not only about what innovation exists to speed up or improve the process. Prior authorizations are impacted by factors such as delays in payer response and legislation. Some of this is being addressed with several states passing bills recently to reform the process creating response time limits and ground rules, while CMS enacted the Interoperability and Prior Authorization Final Rule.
Medigy Insights
Digital/automatic prior authorization efforts are propelling forward thanks to industry accelerators such as the HL7 Da Vinci project, which is developing standards that draw upon subject matter and technical expertise of payers and providers working together to alleviate the burden of prior authorization. Joint efforts to develop, test, implement, and mature these standards indicate promise that the improvements targeted by CMS’ regulations will become attainable in the next few years and reduce delays or abandonment of care and overall burden on providers, payers, and patients.
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