In today’s healthcare landscape, managing prior authorizations is a necessary—but painful—step in the delivery of medical and behavioral health treatment. Not only are prior authorization processes often manual and error-prone, but the administrative burden diverts valuable time and resources away from patient care.

More concerning, delays in obtaining approval can postpone critical care, causing health conditions to worsen and impacting outcomes particularly for vulnerable populations. And if care is denied, whether for failure to meet criteria or inadequate documentation, the appeals process can be complex and time-intensive, further delaying essential treatments.

The right technology can streamline preauthorization processes, minimizing the administrative burden and improving outcomes while reducing costs for plans, providers, and members.

Minimizing Administrative Overhead

Reducing administrative overhead through automation eliminates errors and makes the prior authorization process run more efficiently and consistently. Look for a technology that enables you to tailor workflows to your organization’s processes, promoting efficiency, consistency, and alignment with regulatory requirements. Automated workflows help optimize clinical resources by minimizing unnecessary touches—approving routine requests automatically and routing requests based on your unique rules. With Incedo’s Rules Engine for Auto Processing, routine requests are instantly approved, while cases needing review are flagged, expediting the approval process and keeping clinical staff focused on patient care. This approach not only saves time and reduces costs but also boosts quality metrics, satisfaction, and outcomes.

Clinically Sound Decision-Making

Informed care leads to the best outcomes. Tools that enable you to integrate with decision support within workflows enables your staff to efficiently make clinically sound decisions using objective criteria. Care guidelines help you deliver appropriate, evidence-based treatments while minimizing the overuse or underuse of medical resources. Having up-to-date, embedded guidelines ensure appropriate treatments and reduce overuse or underuse of resources, saving clinicians time with automated next steps. Incedo supports Integrated Clinical Guidelines through seamless connections with industry-leading tools like InterQual and MCG, providing your staff with evidence-based criteria that facilitate accurate and consistent decision-making. Automated workflows can also guide clinicians through next steps, further streamlining the process and saving valuable time.

Comply with Quality Requirements

The best technologies offer quick processing, with automated workflows that help you meet timeliness requirements and other quality performance metrics so you stay in compliance. Ideally your solution will be aligned with NCQA, CMS, URAC, and other regulatory requirements to make compliance, audits, and accreditation processes easier. Plus, it should be configurable to meet your needs, not only supporting different programs with different criteria and auto-routing options, but also configurable to support changing business needs and regulatory requirements so that your technology evolves with your needs.

Incedo’s Configurable Turnaround Times allow you to set due dates and generate reminders based on authorization type and priority, helping ensure adherence to decision and notification timelines. Incedo also enables you to define Configurable Denial Reasons to communicate decisions transparently, with documentation that enhances accountability and simplifies audits. Incedo’s flexibility ensures it adapts to evolving regulatory and business needs, keeping you ready for the future.

Improve Member and Provider Satisfaction

While focused on managing costs and ensuring appropriate utilization of resources, prior authorization can have a significant impact on satisfaction. Delayed care, poor communication, and cumbersome administrative and appeals processes can be frustrating to everyone involved. Efforts to streamline processes and minimize the administrative burden—plus improve communication across the continuum—can contribute to a more positive healthcare experience for members and providers alike.

Look for a technology that enhances communication, streamlining processes and data to put the right information in front of the right people at the right time. Incedo’s electronic Prior Auth Submission/Response allows providers to submit authorization requests through the provider portal and receive immediate responses based on your unique pre-defined rules. This streamlined approach helps reduce delays and improve efficiency, contributing to improved satisfaction and overall care quality.

Streamlined Interoperability and Compliance

Achieving seamless data exchange and interoperability is essential for healthcare organizations to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057). Effective solutions not only support FHIR-compliant data exchange but also streamline integration across systems, ensuring compliance and enhancing workflow efficiency. Incedo’s FHIR API Framework and 278 HIPAA Transaction Support ensure seamless interoperability with external systems and help organizations meet CMS interoperability requirements, making data exchange smoother, compliance simpler, and system integration easier.

Incedo Solves Prior Authorization Headaches

Incedo utilization management technology excels at automating medical and behavioral health management, reducing friction points and replacing repetitive tasks with streamlined, automated processes. By expediting decision-making, enhancing compliance, and supporting interoperability, Incedo empowers your organization to prevent delays, minimize administrative burden, and meet quality performance standards.

Learn more about how Incedo can help you optimize your prior authorization process to speed turnaround, reduce the administrative burden, and improve the patient experience.