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Prior authorization process is a necessary step in ensuring that the patients receive a safe treatment that is medically appropriate for them. It involves getting approval from an insurance company so that any risky or expensive treatments can be covered under the patient health plan.

But these prior authorization solutions come with their own set of challenges. Like prescription refill authorization delays and inadequacies in healthcare data management solutions. It clearly shows that there is a dire need to streamline the prior authorization process by identifying the challenges and opportunities.

Challenges in Providing Prior Authorization Solutions

The prior authorization solutions do provide benefits to all the parties involved, i.e. for pharmacies, patients, payers and prescribers. For instance, getting prior authorization for prescription ensures patient safety, compliance with pharmacy plans, cost management and overall efficiency.

But as the prior authorization requests are increasing in volume, it poses the following challenges:

• Increasing Prior Authorizations and Staff Shortages

It is seen that the prior auth requests have been on an increase in recent years and it has only led to staffing shortages in hospitals. This is because the prior authorization process increases the workload of the hospital staff. They have to spend hours filling in forms and managing documents.

• Prior Authorization Being a Time-Consuming and Frustrating Process

Providing prior authorization solutions is often time-consuming and frustrating as the tasks are tedious. As there are many requests to check and submit, it often leads to mistakes, errors and adds up the associated administrative burden. The healthcare providers get exhausted as they have to deal with rebounding patient volumes. Moreover, if the paperwork goes wrong, it further delays the prior authorization process.

• Many Still Using the Outdated Technology

The prior auth process is already a time-consuming process and the organizations who still use the outdated technology get frustrated more. Many organizations are still not aware of how using the right technology can make the prior auth process efficient and fast.

• Denials in Prior Authorization for Prescription When Done Manually

It is seen that the major reason for prior authorization requests getting delayed or rejected is because of incorrect information. One incorrect or incomplete information can lead to resubmission of authorization from the initial step. These mistakes or errors usually happen when they are done manually.

• Inadequacies in Healthcare Data Management Solutions

There are still many organizations that lack the ability to handle the growing volume of prior auth requests efficiently. Wrong data entries, communications gaps and many other factors result in delays or errors in processing prior authorization requests.

Opportunities Streamlining Prior Authorization Process Brings

Streamlining the prior authorization process comes with a lot of challenges and there is a need to find ways to improve it. But it also offers many opportunities like:

• Automate Prior Authorization Process

By streamlining the prior authorization process, one can manage a large volume of prior auth requests and automate the whole process. The electronic prior auth solutions (ePAs) help in automating the whole process of receiving and requesting prior authorization for medications or treatments.

Every party involved- the payer, patient pharmacy can access it to ensure a seamless flow of communication. Not only does this lessen the days of waiting but also makes the submission process reliable. It also minimized the associated errors that come with manual inputs.

• Train Staff on Prior Auth Requirements

If the staff is educated properly on payer-specific requirements, clinical documentation for prescription drugs and other aspects, it can gradually prevent any challenge. Businesses that offer prior authorization solutions help train staff in their specific requirements.

• Help Manage Clinical Documentation Effectively

Handling clinical documentation is a critical aspect in the prior auth process. By optimizing the authorization process, insurance companies ensure that they are regularly checking and updating clinical documents. They record the details one had with a payor, centralize data storage and use advanced healthcare data management tools to manage clinical documents effectively.

Conclusion

Though there are challenges that come along with the prior auth process, streamlining the authorization process can offer many opportunities that we talked about above. They outweigh the challenges that come with the prior authorization process.