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Part 2: CAQH CORE, Cleveland Clinic, PriorAuthNow

Cleveland Clinic shares how they automated 80,000+ prior authorizations with PriorAuthNow. Use of technology, standards, and CAQH CORE operating rules enable real-time exchange of robust data to accelerate prior authorization adjudication ultimately enabling timelier delivery of patient care.

Key takeaways include:

  • Overall turnaround time was 6.7 days less
  • Over 25% of auths were touchless, meaning no human intervention was required
  • Average interaction time per prior authorization is 4 minutes with PriorAuthNow and 45+ minutes without automation

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Part 1: CAQH CORE, Cleveland Clinic, PriorAuthNow

Cleveland Clinic shares how the implementation of an integrated prior authorization (PA) solution is improving the ability of staff to conduct PAs and creating a more efficient process. This is the first case study webinar in a series related to the CAQH CORE Prior Authorization Pilot & Measurement Initiative, which works with industry organizations to measure the impact of standards and operating rules on efficiency metrics and staff experience.

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Case Studies

A regional children’s hospital implements PriorAuthNow in 90 days

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

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An 850-bed health system in Michigan uses PriorAuthNow to increase staff productivity by 200%

The manual prior authorization process created significant negative impacts for a centralized authorization department at a health system in Michigan.

  • Achieved over 200% improvement in staff productivity
  • Saved 55% on prior auth processing staffing costs
  • Achieved a 40% increase in prior auth determinations every month

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Helpful Resources

Moving Beyond Electronic Processing of Prior Authorizations to True Automation

Many healthcare providers want to move to electronic prior authorizations (ePAs), but finding an effective solution can be tough. It’s not enough for the process to be digital – providers must automate the prior auth process to achieve meaningful efficiencies and accelerate patient access to all types of care.

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10 questions to ask your prior authorization vendor

Here are the top questions we hear from providers when they talk to us about prior authorization automation.  

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Building a company people will love and a product that changes lives through constant iteration

CEO & Co-Founder Joe Anstine speaks with Conquering Columbus about changing the fragmented and broken process of prior authorizations in the personal healthcare space (and single-handedly putting the fax machine industry out of business). With no previous experience or background in healthcare, Joe has grown himself into an expert in the field of prior authorizations in the personal healthcare space by listening to his customers, being a sponge for information, and constantly adapting his product to fit his customers’ needs.

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Addressing problems associated with prior authorizations

Highlights of this episode include:

  • Background on prior authorizations and how providers manage them
  • What problems do healthcare providers face when dealing with prior authorizations?
  • How providers and payors can work together to help solve problems with prior authorizations
  • What healthcare providers can do to become more more efficient with their manual processes

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