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Streamlining Prior Authorizations for EMR Customers

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The healthcare industry constantly seeks to increase operational efficiency and provide better patient care. Getting medical prior authorizations for essential procedures, treatments, and medications is a significant obstacle that healthcare organizations encounter.

The industry can now rely on Robotic Process Automation (RPA) technology to simplify and speed up obtaining prior authorization for those who use a healthcare EMR, such as Meditech, Epic, eClinicalWorks, and Oracle Cerner, to give some examples. This technology allows for the creation of automated processes that accurately and swiftly secure the necessary approvals. The benefits of this technology include:

  • A more efficient process.
  • A reduction in the time and resources needed to secure authorizations.
  • Improved patient care.
  • Better operational efficiency.

What is Robotic Process Automation (RPA)?

RPA technology pertains to the utilization of software-based robots or “bots” to automate tasks that are repetitive and based on rules. These bots can replicate human actions, interact with different software systems, collect and process data, and perform tasks precisely and quickly.

Processing Prior Authorizations in a Batch Mode

Previously, getting approval for medical appointments was tedious and time-consuming, often just before the appointment. Healthcare professionals and staff were burdened with paperwork, phone calls, and insurance follow-ups. Thankfully, RPA is the solution needed to solve this problem, and reduce administrative strain. For those utilizing the EMR platforms, RPA can process prior authorizations in bulk. As a result, EMR users can effectively manage large quantities of prior authorizations using this technology. Here are some tips on how to make the most of this technology.

Data Extraction and Validation

RPA can be used to automate the extraction of patient data from EMR systems. This data can include medical history, diagnosis codes, and treatment plans. Automating this process ensures that the data is accurate and up to date and meets the requirements of the patient’s insurance carrier. After extracting the data, it’s cross-checked with the insurance company’s requirements to ensure that all information is accurate and complete before submission.

Insurance Eligibility Verification

Bots retrieve insurance information from various payer portals and cross-verify it with patient records stored in the EMR system. Organizations can quickly identify discrepancies or coverage issues by automating this process, reducing the risk of claim denials and delays. The bots can be programmed to retrieve and analyze the data, allowing organizations to identify any potential issues quickly and accurately easily.

Prior Authorization Submission

RPA bots can send prior authorization requests to insurance providers after checking patient information and insurance coverage. They use predetermined templates with necessary data and medical documentation to reduce manual labor and speed up the authorization process.

Tracking and Follow-up

RPA can continuously monitor the progress of prior authorization requests by integrating with insurance portals and receiving real-time updates. Bots can automatically flag any pending or delayed authorizations, triggering appropriate follow-up actions, such as resubmission or escalation. This proactive approach minimizes the risk of missed deadlines and improves the efficiency of the overall process.

Analytics and Reporting

Using RPA, organizations can access detailed reports and analytics that provide valuable insights into prior authorization activities. This data is essential to evaluate performance, optimize workflows, and improve decision-making processes. Analyzing trends and patterns can also help identify areas for further automation or process improvement.

In conclusion, leveraging automated solutions for Prior Authorization in healthcare EMR has streamlined the complex process of collecting all the necessary parameters and requirements from patients, insurance companies, and providers. It offers immense advantages in speed, accuracy, reliability, and scalability. It eliminates tedious manual processes and allows medical facilities to automate their Prior Authorization processing workflow. It facilitates data extraction and validation while providing accuracy through Insurance Eligibility Verification. Additionally, the automation solution ensures that real-time tracking and follow-up are incorporated into the system, along with advanced analytics, to provide a complete overview of what works best for businesses. To optimize the EHR Prior Authorization process, taking advantage of RPA is essential for putting your healthcare organization on the journey toward success.

About SphereGen

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SphereGen is a unique solutions provider that specializes in cloud-based applications, Intelligent Automation, and Extended Reality (AR/VR/MR). We offer full-stack custom application development to help customers employ innovative technology to solve business problems.

Learn more about what we do in RPA: https://www.spheregen.com/robotic-process-automation

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