Best Prior Authorization Products
Currently, we have identified 21 digital solutions in the prior authorization space, many of which integrate with leading systems like Epic, Cerner, Meditech, Allscripts, McKesson and others. This means you can choose a prior authorization solution that meets the unique needs of your healthcare organization and patients.
What’s more, our verified client data for these solutions shows that dozens of health systems are already using prior authorization solutions. This demonstrates the growing acceptance of this technology among healthcare providers as a means of improving patient outcomes and reducing healthcare costs.
Prior authorization is a crucial management process in healthcare that ensures healthcare providers receive approval from payers before delivering specific services, preventing lost revenue and reducing expenses. AVIA Marketplace offers a range of digital health solutions and software designed to streamline the prior authorization process, enabling healthcare providers to focus on delivering quality care to their patients.
On this page, you'll find a curated list of prior authorization solutions, software, and tools that automate prior authorization requests, streamline workflows, and reduce administrative burdens. Our solutions help healthcare organizations to save time and resources, avoid denials and delays, and improve overall revenue cycle management.
At AVIA Marketplace, we're committed to providing the information and resources needed to make informed decisions about the right prior authorization software, solutions, and tools to implement in your healthcare system. Browse our listings and learn more about how our solutions can help streamline your revenue cycle and improve your bottom line. Search AVIA Marketplace for the top prior authorization solutions from leading vendors in the industry.
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With the MCG Cite AutoAuth, payers and providers can rely upon an automated, evidence-based system to facilitate the prior authorization process. The web-based interface, provided through the payer’s portal, makes it easy for a provider to document and support treatment requests.
EMRs supported | Epic, Cerner |
Solutions | Medical Benefit Prior Authorization Tools |
Keywords | artificial intelligence, prior authorization, clinical decision support +2 more |
Categories | Prior Authorization, Revenue Cycle Management |
EMRs supported | Epic, Cerner, Allscripts +2 more |
Solutions | Referral Management Software Solutions, Medical Benefit Prior Authorization Tools |
Keywords | epic training, digital front door, productivity +2 more |
Categories | Care Transitions, Referral Management, Prior Authorization +1 more |
Direct is the leading EHR-integrated cost transparency solution. The solution brings real-time, medical and pharmacy benefit cost information, coverage restrictions, and alternatives into native EHR workflows. Giving providers cost information at the point-of-care enables data-driven and evidence-based decisions that help patients get the care they need at prices they can afford.
Features and Benefits:
- Access to lower-cost alternatives increases care adherence and patient health and satisfaction
- Select care/medications that do not require prior authorization
- Reduced pharmacy/PBM/payer call-backs, prior authorization denials, and other uncompensated provider hassles
- Uses native order workflows, is easy to implement
EMRs supported | Epic, Cerner, Athenahealth |
Solutions | Prescription Prior Authorization Platforms, Clinical Decision Support Systems |
Keywords | prescription decision support, real time prescription benefit, real time benefit check +4 more |
Categories | Clinical Decision Support Systems, Clinical Decision Support, Care Plans +1 more |
Olive’s End-to-End Prior Authorization solution seamlessly connects to provider EHR systems, accelerates the prior authorization process, and empowers healthcare providers with an efficient prior authorization workflow management system, supplemented by automation and augmented by AI. Olive recommends a succinct clinical bundle to improve authorization approvals leading to increased revenue and patient throughput. Additionally, Olive includes comprehensive medical necessity criteria for tens of thousands of procedures to help you understand payer requirements and include better supporting clinical documentation, resulting in more first-pass prior auth approvals and reducing prior auth denials.
EMRs supported | Epic, Cerner, Athenahealth +1 more |
Solutions | Medical Benefit Prior Authorization Tools |
Keywords | prior authorization, revenue cycle management, operational effiency +2 more |
Categories | Prior Authorization, Revenue Cycle Management |
EMRs supported | None provided |
Solutions | Medical Benefit Prior Authorization Tools |
Keywords | automation, intelligent automation, prior authorization +3 more |
Categories | Prior Authorization, Revenue Cycle Management |
EMRs supported | None provided |
Solutions | Medical Benefit Prior Authorization Tools, Referral Management Software Solutions |
Keywords | None provided |
Categories | Prior Authorization, Revenue Cycle Management, Referral Management +1 more |
EMRs supported | None provided |
Solutions | Medical Benefit Prior Authorization Tools |
Keywords | None provided |
Categories | Prior Authorization, Revenue Cycle Management |
EMRs supported | None provided |
Solutions | Medical Benefit Prior Authorization Tools, Revenue Cycle Management Services |
Keywords | None provided |
Categories | Prior Authorization, Revenue Cycle Management |
Automated processing of paper-based prior authorizations. We are able to ingest any paper form, semantically understand the content, extract entities, and feed those to your downstream systems via API. Our end-to-end proprietary pipeline is tuned to the language and processes of healthcare, insurance and banking. The result? Consistent quality that is better than human.
EMRs supported | None provided |
Solutions | Medical Benefit Prior Authorization Tools, Clinical Decision Support Systems |
Keywords | None provided |
Categories | Clinical Decision Support, Clinical Decision Support Systems, Care Plans +2 more |
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Contents
Prior authorization is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.
Prior authorization–sometimes called precertification or prior approval–is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses. When patients seek prior authorization–typically for more complex or costly treatments or prescriptions–payers may approve or deny requests, ask for more information, or require that the patient receive an alternative treatment before approving the initial request.
The current prior authorization process is extremely burdensome and time-consuming–the average physician must complete 41 prior authorizations per week, which translates into about 14 labor hours just for completing prior authorizations, according to a 2020 American Medical Association survey. It's also one of the most costly administrative transactions, with an average expenditure of about $11 for each request. But the prior authorization landscape is changing, and the lost time and sunk costs are decreasing as intelligent automation becomes commonplace.
While a manual prior authorization takes an average of 21 minutes, a digital transaction can be completed in about four minutes, with fewer denials and faster turnaround time.
While the steps remain unchanged between digital and manual processes, an end-to-end automated solution alleviates the administrative burden and virtually eliminates errors that can lead to delays and denials.
Requirements identification
Top solutions automate whether a prior authorization is required and can identify payer-specific rules without additional manual research from staff.
Requirements knowledge base
The prior authorization requirements knowledge base should be continually and automatically maintained, with minimal (if any) support from the health system.
Automated form completion
Leading prior authorization solutions integrate with the EHR and leverage structured and unstructured data to populate the appropriate fields and save time for physicians and staff.
Forms library
End-to-end solutions should include a forms library, where necessary payer-specific forms can be created and maintained.
Documentation collection
Intelligent documentation collection automatically pulls necessary documentation from the EHR and helps reduce denials based on incomplete or missing information.
Automated request submission
Capabilities should include automated submission on behalf of the provider through efax, payer portals, third-party sites and other access points.
Status monitoring
The leading solutions offer continuous status monitoring and push update and other relevant information back to the appropriate work queues and fields in the EHR.
Before implementing end-to-end automation in the prior authorization process, hospitals and health systems must:
Other capabilities that health systems should deploy to successfully implement digital prior authorization include: