ReferralMD automatically checks health plans and reduces manual tasks associated with prior authorization. ReferralMD’s prior authorization solution uses machine learning and AI-enabled processes that recognize patterns from health systems. Workflows are dynamically updated to reduce denials and payment delays. Increase efficiency by reducing time-consuming manual processes. With seamless payer connections, connect to health systems for up-to-date benefits and patient OOP responsibilities.

With ReferralMD healthcare practices can automate prior authorization workflows. From the moment a physician refers a patient, all the way to submitting, verifying, and tracking a prior authorization. Seamlessly integrated with your existing practice software and workflows.

No need to manually cut and paste data from portals. No need to fax forms, play phone tag, or sift through emails. ReferralMD connects directly with your EHR, LIMS, pharmacy management, or revenue cycle solution.

Features

• Autonomous execution of complex precesses with immediate response at point of service.

• Medical and pharmacy benefits coverage for over 93% of U.S. covered lives.

• Direct connection to payers in the U.S. to support near real-time decisions.

• Thousands of payer-specific rules for benefits and prior authorizations.

• Self-learning to update workflows through feedback loop from payers/claims systems.

Benefits

• Reduce time-consuming manual efforts by up to 70% and eliminate rework by up to 90%.

• Capture most accurate patient responsibility data to improve collections at point of service.

• Reduce turnaround time by >90% to respond to referring physicians and patients in minutes.

• More than 25 % productivity gains in <6 months by eliminating siloed, tribal knowledge-bases.

• Reduce denials and improve payer collections by over 20%

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