What Is An Electronic Prior Authorization

If you are a healthcare provider, we don’t need to tell you the huge burden of prior authorization. After all, it is very time-consuming.

The overall process is as follows: the order is placed by the provider which is routed over thru one of many different methods to a staff member in the office.  The first step is does the order require a prior authorization which leads to a phone call or a web site inquiry which is very time consuming.  Once it has been determined the authorization is required the administration team creates and submits the necessary forms waiting on the insurance for approval. At this point, the authorization can either be approved or denied. However, in specific cases, more information may be needed before the final decision is made.

It’s not difficult to understand that this manual method has a lot of disadvantages for both healthcare providers and patients. It takes time, resources, and you never know when it will actually be complete. This is why more and more healthcare providers are already using electronic prior authorization.

What Is Electronic Prior Authorization?

Simply put, electronic prior authorization is a software that allows healthcare practitioners and patients to reduce the time and resources wasted with the traditional prior authorization method.

One of the positive effects of the COVID-19 pandemic is that healthcare providers are more willing to adopt new technologies. During the toughest periods, healthcare providers were able to look for ways to minimize points of friction in the prior authorization process and just take the patient out of the middle.

The reality is that many health plans have changed their policies during the COVID-19 pandemic. However, the urgency for electronic prior authorization adoption should remain even when the pandemic is over.

How it works is, the electronic prior authorization software usually interfaces directly into electronic health records (EHRs) to provide an almost real-time approval for many provider orders. Just to give you an idea about what the COVID-19 pandemic has changed, 14 states already require electronic prior authorization as of April 2021 and 16 states will allow it. The remaining states have pending electronic prior authorization legislation.

Why Is Electronic Prior Authorization So Important?

According to an independent evaluation conducted at the beginning of 2020 and that took nearly one year, RTI International decided to analyze prior authorization transaction data before and after implementation of electronic prior authorization. 

In the data gathered, RTI International discovered that 71% of providers who used electronic prior authorization reported faster time to patient care. It was also noted that the time between submitting a prior authorization request and receiving a decision from the health plan decreased by nearly 70%. 

The use of electronic prior authorizations also decreased the time spent on phone calls as well as on faxes sent. But one more important point is related to the fact that there is an improvement in the transparency of prior authorization requirements for providers who implemented electronic prior authorization.

The cherry at the top of the cake belongs to patients who no longer need to wait so much time for approval. It is also important to note that health insurance providers are committed to using proven technologies like electronic prior authorization to improve patient care and provider experience.

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