In healthcare, prior authorization is an important process where providers must obtain approval from insurance payers before delivering specific medical services. While this system aims to manage costs and ensure the appropriateness of care, it often leads to significant delays in patient treatment. Alarmingly, one in three providers reports that these delays hinder timely patient access to care, highlighting the urgent need for improvements in the authorization process.
The traditional approach to prior authorization is manual and time consuming. Providers typically spend substantial time verifying patient insurance details, reviewing medical records, submitting authorization requests, and following up with insurance companies. This often involves lengthy phone calls, navigating complex online systems, and dealing with long wait times. If an authorization request is denied, providers must prepare additional documentation or appeal the decision, further complicating the process and extending wait times for patients.
In contrast, automated prior authorization process automation offer a more efficient solution. These technologies can swiftly retrieve necessary patient data, validate information, and prepare authorization requests in a fraction of the time required for manual processes. By streamlining workflows, automated systems can save provider groups operating with five or more prior authorization team members up to 24 hours of wasted time each day. Furthermore, processing a patient’s information and scheduling appointments can take as little as five minutes, significantly reducing delays.
The impact of the current manual system on healthcare providers is profound. With 35% of providers hiring additional staff solely to manage prior authorizations, administrative burdens have soared, with nearly 93% of physicians reporting high levels of stress related to these tasks. Delays in prior authorization can also have serious consequences for patients, increasing the likelihood of hospitalization by 25% and posing a 19% risk of life-threatening events.
In this challenging landscape, Orbit has emerged as a game-changing solution. The company’s AI-powered prior authorization automation system has demonstrated remarkable effectiveness, saving providers around 60% in costs and generating approximately $449 million in savings across the U.S. healthcare industry. Beyond financial advantages, Orbit’s technology enhances patient experiences by accelerating the delivery of care and improving the accuracy of data collection.
By reducing turnaround times and freeing up staff resources—allowing team members to reclaim nearly 12 hours a week—Orbit addresses the pressing issues surrounding prior authorization. Ultimately, this innovative approach paves the way for a more efficient, patient-centered healthcare system, ensuring that patients receive timely and appropriate care without unnecessary delays.
Source: Orbit Healthcare