Prior Authorization Specialists: Reduce Delays, Improve Patient Experiences and Drive Efficiency

The Problem

Patients face numerous barriers when accessing healthcare. The utilization management method of prior authorization for medications (not considering PAs for medical procedures) is one such barrier that still continues to frustrate many while also being directly responsible for over 1 out of 4 patients abandoning their prescription.

Like patients, healthcare providers also struggle to cope with the prior authorization burden as it leads to increase in administrative workload and other complications. This administrative workload can get out of control in no time, if necessary steps are not followed when requesting authorization from an insurer. Consequences of errors in the prior auth process include:

For Patients – Delayed care, prescription abandonment, negative impact on physical and mental health and more.

For Healthcare Providers – Increase in administrative tasks, average time-to-therapy, additional costs, PA denials, and more.

A report highlighting the ‘problems with prior auth’, by researchers at Harvard Medical School, presented at the 2023 ASCO annual meeting, found that “pre-authorization policies resulted in an almost two-week long delay for prescription refills”. Another 2023 study by Harvard University researchers analyzing “Utilization Management Trends in Medicare Part D Oncology Drugs, 2010-2020”, found that “prior auth requirements for branded specialty and branded non-specialty oral cancer drugs increased by 22.6% and 62.3% respectively in 10 years.

While policymakers try to put in place reforms that are in the best interest for all, healthcare providers must also look for ways to ensure smooth prior authorization processes that minimize delays and reduce administrative costs and workload.

These problems posed by preauthorization requirements and the opportunities arising out of their resolution are best summarized by a quote by American author and motivational speaker, Tony Robbins, who said, “Every problem is a gift. Without them we wouldn’t grow.”

The Solution: Prior Authorization Services That Reduce Delays and Costs for Patients, while Driving Operational and Fiscal Efficiencies for Providers

There’s no doubt that growing prior auth requirements are a major problem, but they present opportunities too; the opportunities to streamline processes, reduce labor and operational costs, improve patient experiences and optimize revenues.

To tap into these opportunities, it is important that healthcare providers get more time to focus on their core competency; delivering quality medical care, and outsource non-core competency functions like non-clinical operations to prior auth experts with deep domain knowledge and proven expertise.

From our nearly two-decade long experience in securing prior authorization for medications and medical procedures across multiple specialties, we have developed a comprehensive range of medication prior authorization services with value-added offerings that are sure to exceed your expectations.

  • Medication prior authorization services:
  • Electronic prior authorization (ePA)
  • Clinical review
  • Drug utilization review
  • Documentation audit
  • Follow-up services
  • Value-added offerings
  • Interconnectedness and improved visibility through automation tools and software
  • Customizable reporting
  • Medical answering services
  • Our performance in numbers
  • Average time-to-therapy reduced by almost 30%
  • Automated PA denial management boosted efficiency by over 50%
  • Reimbursement maximized by 30% to 55% in the first three months
  • Reduction is turnaround time for approval by 42%
  • Reduction in operational costs by almost 80%

To enquire about our prior authorization services or for more details about our industry references and achievements, please consider booking a quick and free (no strings attached) consultation, or call Sunknowledge Services Inc., a trusted and HIPAA-compliant end-to-end RCM company helping healthcare providers reduce costs and streamline operations.