regional childrens hospital integrates with PriorAuthNow

Case Study

Regional Children’s Hospital Completes Medical Prior Authorization Automation Integration in 90 Days with PriorAuthNow

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Happy provider after implementing PriorAuthNow

The Challenge

A regional children’s hospital needed to automate prior authorizations quickly due to expanding authorization requirements from insurance companies. They needed a cost-effective way to scale demand with limited resources and time.

The Outcome

Integration was completed in 90 days including establishing standard 278r, VPN, and work queues without an operational project manager.

Looking for an Expert in Prior Authorization Automation

Often, when a health system signs on with a new software partner, it results in a lengthy integration process. It typically involves dedicated resources from both the software company and the health system. There can be major roadblocks that prohibit the completion of the integration. This may include unforeseen technical delays, limited resources, competing projects, and budgets.

When the regional children’s hospital was evaluating potential software solutions to handle their need for prior authorization automation, it was crucial to find a partner who had the ability to scale, expertise to keep up with constant changes in prior authorization requirements, and capability to build custom workflows for each specialty supported.

Why the children's hospital chose PriorAuthNow

PriorAuthNow was the regional children’s hospital partner of choice because of our innovative approach to solving the prior authorization problem and thorough knowledge of authorization procurement.

The regional children’s hospital was also impressed with PriorAuthNow’s approach to implementation. This included a dedicated team of experts with representatives from both organizations working together. This is extremely important to properly assess and deploy workflows to ensure the most efficient and automated processes around prior auths from submission to completion.

Starting from Scratch

The regional children’s hospital was uniquely challenged with the hurdle of lacking a 278R interface, VPN connection and useable work queues. Typically, not having these previously built may delay implementation.

Items needed for PriorAuthNow automated prior authorization implementation.

The hospital was also unable to dedicate a project manager, requiring PriorAuthNow to act as project manager on both sides. This was a challenging responsibility to hold both teams accountable to complete action items and necessary steps on time.

Fortunately, these unforeseen hurdles did not negatively impact the regional children’s hospital time to go-live and they were thrilled to be able to start using the software within just 90 days.

An Engaged Team

The regional children’s hospital had executive sponsorship from the beginning including the Vice President of Revenue Cycle and the Director of Patient Access, both of which were actively engaged throughout the entire implementation. They were able to keep their team accountable from a high level and were resourceful escalation points if and when needed.

PriorAuthNow worked with the regional children’s hospital staff to take a consultative approach in understanding the nuances of their workflows and determined the most efficient workflow moving forward. This meant figuring out how to reduce the number of repetitive, manual steps required for preauthorization determinations to the quickest turnaround time possible. This not only gave time back to the patient access staff, but increased employee and patient satisfaction.

Manual prior authorization process is labor intensive
Manual Prior Authorization Process

While PriorAuthNow acted as the project manager on both sides, a comprehensive action item plan was used, which helped speed up the process. The plan was simple and clear with dates and expectations to keep both teams accountable to the end goal. Weekly meetings helped keep the team on track and the Epic technical support team assigned to the hospital was engaged from the beginning.

A Succinct Timeline

PriorAuthNow implementation timeline

Once the interface build and VPN connection was established, a series of tests occurred. PriorAuthNow tested a variety of mock scenarios through the platform and the hospital’s workflows. This testing ensured that PriorAuthNow could communicated prior auth information to payors, no matter the situation. After testing, PriorAuthNow provided comprehensive training sessions with all end-users to ensure they felt comfortable and prepared for a successful go-live.

The hospital started with a soft go-live where their workflow began manually and their cases were submitted to one payor. This allowed the patient access team to have more control over the integration to work out any kinks that could arise during the transition to automation.

When the hospital and PriorAuthNow both felt comfortable with the result of the manual workflow, the automated workflow was turned on with more payors and more specialties, allowing for touchless prior authorizations.

“The PriorAuthNow implementation was the smoothest vendor experience in my healthcare career. Our Implementation Manager supported us every step of the way. He ensured that all of the necessary participants were included in our regularly scheduled calls, while maintaining all of the tasks for both PriorAuthNow and our teams.  I was extremely impressed with PriorAuthNow’s openness to all of our ideas, as well as, their quick response to any issues or concerns.  The involvement and feedback of our front end users in the build, testing and implementation eased the adoption and acceptance of this new workflow. The engagement and collaboration from both organizations technical and operational participants made this venture a success.”

-Director of Patient Access

After Go-Live

Once the hospital went fully live with prior auth automation, the PriorAuthNow team scheduled weekly and bi-weekly status calls with the end users and held discussions about opportunities for product enhancements to further improve the hospital’s experience with PriorAuthNow.

We Are the Prior Authorization Experts

Prior AuthNow is the leading platform for medical prior authorization automation. We link a network of providers, payors, and EHRs to streamline the prior authorization process. Our platform brings direct-to-payor connectivity directly within the provider workflow for touchless prior authorizations.

It’s time your health system started automating medical prior authorizations. PriorAuthNow can help.

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