Automation: The Key to Alleviate Pre-Authorization Process Hindrances

Automation process

  “88 percent of prior authorizations are still either partially or completely manual.”

Healthcare service providers and patients can truly understand the significance of authorization of medical claims from the payers as without getting approval on the same, the payment of a patient’s medical service (as part of a healthcare insurance plan) can be refused.

This not only causes trouble for the patients but also halts the procedures to be conducted on the service provider’s end. 

To go with the definition, 

Pre/Prior Authorization of Precertification (PA) is an obligatory approval to be taken in advance by the provider from the insurers to get reimbursed properly and timely. A certification number is provided by the payer for the medical services procured by the patient that will be paid once pre-authorization gets approved.


Demystifying the pre-authorization process can act as a transitory point in revamping the patient outcomes and experiences. And pivoting on the prior-authorization process with advanced techniques can aid medical practices to accelerate approvals, increase patient care, and collect more revenue, ultimately.

Did you know?

More than 60% of the physicians reported that they have witnessed prolonged wait times on the decision to be made by the insurance payers over pre-authorization of claims.


Insurance verification and Precertification of claims need not be made complicated and must be empowered by automation to eliminate the greatest hindrances coming in the way of providing quality care. 

Outlining patient benefits and coverage for any medical procedure (before providing the service) is quintessential for smooth reimbursements and can be leveraged with robotic process automation (RPA). And insurance verification checks and prior authorization are those countable tasks that can be synthesized and optimized using automation.

Intelligent Pre Authorization

Intelligent Prior-Authorization enables to procure approvals nimbly, avoiding data errors, with AI-driven RPA bots that orchestrate patient access workflow, thus, obtaining insurance verifications, pre-authorizations benefit checks well in advance.

“RPA allows automating redundant erroneous manual tasks that fluid data consistency and provide high interoperability, ensuring high-quality care while concurrently controlling healthcare spending.”

Automation is the key to reduce Pre-Authorization burdens. Bolstered by tech advancements, the overall process can be made highly efficient, predictable, and uniform while scaling operational excellence and, ensuring a high volume of reliable data exchanges, and mitigating risks of disapprovals.

[Prefer Reading: Alleviate your Medical Practice’s Operational Challenges via RPA Implementation]

How Automation Streamlines the Workflow for Pre-Authorization?

#Automation offers Data Consistency

Requirements for authorization differ with the change in the coverage and health plans. This becomes the major reason for the lack of uniformity in submitting adequate information to the payers from the end of the healthcare service providers and limits the adoption of the standard transaction as well.

Implementation of Robotic Process Automation alleviates these shortcomings by offering increased transparency and administrative excellence by structuring crucial data and codes information appropriately through electronic means.

Electronic prior authorization capabilities remove data inconsistencies and manual errors, enabling all the significant segments of the pre-authorization process to happen automatically and periodically. This made it easier to manage this wing of RCM for all those involved.

[Prefer Reading: Shore Up Financial Health & Resiliency with Modern RCM Strategies]

#Automation Structures the Standard Clinical Documentation

Clinical documentation has a major role to play in the medical billing cycle where the attachments and patient data files help to determine the medical necessity or appropriateness by explaining the patient’s medical position.

However, lack of data accuracy, improper attachment standards, or non-uniformity across plans certainly leads to inconsistency in getting authorization approvals and further in the dependent procedures of Revenue Cycle Management.

The overall data management within the entire medical billing is precisely overseen by automation bots that process the patient data with 98% accuracy, adhering to the compliance and documentation formats.

The standards to execute clinical documentation are met by digital workers that ease the flow of acquiring easy pre-authorization approvals. 

#Automation Overcomes Administrative Lags through Transparent Communication System

Clear and legible communication between service providers and payers can only form the basis of acquiring successful prior authorization grants. 

Modern EHR systems powered by AI-driven automation can efficiently synchronize data between platforms connecting providers and payers, maintaining close privacy and security.

The main motive is to promptly identify (with accurate patient data) whether a specific treatment, relevant documents or medication process needs prior authorization or not. 

Moreover, automated systems act as a solution to accept previous insurer’s prior authorization in the case when a patient changes its healthcare service provider. This transition leads to the emergence of a new process with repeated medical service protocols which may impact on patient’s health too.

Thus, an established RPA system can help deliver quality care while keeping the data secure, updated, synchronized, and ready whenever the need arises. 

Adopting automation solutions like Electronic PA would drastically eliminate time-consuming manual processes and maximize revenue, and automates all the prior authorization tasks.

  • Reduce patients’ and providers’ administrative burden
  • Provide real-time data on patient payment
  • Reduce denied claims & provide more accurate data
  • Increase the count of reimbursements
  • Enhance practice’s productivity

[Prefer Reading: 6 Ways Revenue Cycle Management (RCM) System Reduces Errors & Increases Revenue]

Do you pay a Cost of not Using & implementing RPA in your Practice?

Robotic Process Automation is an ideal solution to orchestrate the entire revenue cycle management by eliminating errors caused by miss-keyed data and simple human mistakes. The robots employed are programmed to complete billing tasks using their intelligence and render accurate data outcomes.

With humans prone to making errors, businesses not using RPA proven techniques and solutions can let their administrative tasks fall to employees to oversee that would certainly output inconsistency, inaccuracy, and unwanted results.

Being one of the vital segments of the RCM, prior authorization is a necessary and important tool for payers to ensure program integrity, but there is a better way to make the process work more efficiently by supporting it via automation to ensure that care is not delayed and administrative costs are not increased anywhere in the system.


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