Best Prior Authorization Products

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

There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble: - Automatically verifies, initiates, statuses and retrieves comprehensive authorization details - Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes - Integrates directly with all major HIS and PM systems - Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity - Adapts to constantly shifting payer rules and requirements - Was built and is maintained by our in-house team of experts

Make your operations more efficient: With Passport Authorizations, inquiries take place without user intervention, as does status monitoring. Submissions guide staff through the workflow, auto-filling all information Experian Health has received and prompting users only if their involvement is required. Access the industry’s most complete payer database: Experian Health's pre-authorization knowledge base stores and dynamically updates payer prior authorization requirements. Your staff can check whether prior authorization is required for a particular procedure or service, and the knowledge base automatically responds to queries with information needed.

VALER is a cloud-based **Enterprise Authorization Platform** that streamlines and automates today's manual authorization workflows. VALER provides **ONE place to SUBMIT and VERIFY authorizations across all payors and all services types** (professional, facility, ancillary, medications, etc). VALER is the only solution that manages authorization submissions for both payor **FAX** and **web portal** based workflows. VALER provides enterprise-wide visibility on **real-time authorization status** and documentation to eliminate duplicate work and support the revenue cycle.

Notify patients of pre-auth status and co-payments due. Included with payment reminders.

These automated processes, which are part of the R1 Patient Experience, deliver accurate and complete authorizations directly within order and scheduling workflows to reduce administrative tasks, lower operational cost, streamline appropriate payment, and enhance the patient experience. With R1 Financial Clearance clients are able to get to “Schedule Ready” faster with sixty-seven percent of authorizations cleared within minutes and ninety-seven percent within 3 business days.

Obtaining pre-authorizations without delay is essential to both preventing unnecessary delays in care and ensuring accurate reimbursement for services provided. But there are multiple challenges to administering an efficient, effective pre-authorization program, including: • Recruiting and retaining staff who have both clinical and revenue cycle expertise • Dedicating resources to stay up to date on complex, evolving guidelines and payer-specific requirements, and to manage payer responses • Lack of a consistent, technology-enabled workflow An Efficient Solution: Our Authorization Management Services staff manages pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission. Our solution includes: • Authorization Experience and Expertise – Our services are provided by clinicians (nurses or allied health depending on client need) who have specialized education in authorization requirements and commercial screening tools. Our team members average more than five years of clinical and authorization experience, stay up to date with training and compliance, and are dedicated to helping ensure that no part of your authorization request slips through the cracks. • A Centralized and Streamlined Technology Process – Our team leverages a centralized system to accelerate payer response, with processes that are efficient and repeatable. We incorporate robotic-process automation to assist with account statuses and system updates. • Thorough Authorization Clinical Review – Our team reviews each medical record, focusing on payer-specific requirements and obtaining authorization for services scheduled or rendered. We stay abreast of changes to Medicare, Medicaid, and commercial payer guidelines. • A Focus on Reducing Authorization-Related Denials – We take a holistic approach to authorization, which includes working auth-related denials. We review denied admissions, days, and services, and complete all necessary steps for reconsideration and appeal requests. Our denial workflow is customized so that we can pair expertise to the type of denial; for example, leveraging technical versus clinical staff depending on the reason for denial. • Detailed Performance Reporting – We provide detailed performance reporting that includes a month-over-month view of account activity including: √ current status √ completion percentages √ approval percentages

Help Accelerate Prior Authorization: - Automate manual processes by determining if a pre-authorization is required and on file with the payer. - Create a consistent workflow for manual intervention of pre-authorization follow-up to ensure mission-critical steps are not overlooked. - Help reduce losses due to write-offs by automating Medical Necessity checking as part of registration, and perform clinical code auditing for Medicare outpatient services. - Monitor payers electronically for pending pre-authorization decisions with results automatically posted to your health information system. - Help reduce authorization-related claim denials by accessing an audit trail where the authorization verification was obtained and results were stored. - Create Advanced Beneficiary Notices with expected charges for the patient which allows them to accept liability prior to care delivery.

Our design-first, end-to-end automation platform solves the problems of authorizations, while building better relationships between health plans, providers, and patients to encourage collaboration and drive better outcomes.