Avia Logo
Write a review

 Categories /Best Prior Authorization Products

Best Prior Authorization Products

Best Prior Authorization Products

Currently, we have identified 24 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. 

Read more
3 products
Product Logo
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
Rated In Top 10%
Rated In Top 10%
Versatile platform
Versatile platform
5+ years in business
5+ years in business
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
View full profile
key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
To see which organizations are using this product, sign in or create a free account.

Visit Website

Need help narrowing down products?

Add more criteria to see your compatibility level for every vendor. It only takes a few minutes, just create a free account to get started.
Product Logo
Versatile platform
Versatile platform
Versatile platform
Versatile platform

The Digital Clinical Assistant is your solution to the prior authorization process. The Digital Clinical Assistant leverages innovative AI technology and a digital workforce to automate the burdensome process within Athenahealth EHR- eliminating the need to learn new tech or add to existing workflows. As a result, the DCA can improve the time to approval by up to 50%, increasing the number of approvals you can process daily. In addition, the DCA can reduce the cost of prior authorization by up to 60% and alleviate the administrative burden on your staff.

View full profile
product capabilities
Requirements Identification
Requirements Knowledge Base
Form Completion
Forms Library
Documentation Collection
Request Submission
Status Monitoring
See more
key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
To see which organizations are using this product, sign in or create a free account.

Visit Website

  • Janus Health Prior Authorization supports the full auth process, from determination to statusing.
  • Seamless EHR integration enables your team to operate within their established workflows, maximizing efficiency and boosting employee satisfaction. Intelligent automations allow staff to avoid unnecessary follow-up, working only those auths that demand attention. Plus, cover more of your specialties like radiology, cardiology, surgery, and more, across ~80% of your payer mix.
  • Experience enhanced operational efficiencies that support employee retention, save valuable staff time, and reduce authorization-related denials, increasing revenue and reducing cost-to-collect.

View full profile
product capabilities
Requirements Identification
Requirements Knowledge Base
Request Submission
Status Monitoring
See more
key clients
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
To see which organizations are using this product, sign in or create a free account.

Visit Website

Filter product grid


By Org's Client Size

Product Grid

Filter product grid


By Org's Client Size

AVIA Marketplace offers a product grid that is a comprehensive resource for health care buyers in their research journey. The grid showcases products from leading vendors and ranks them based on compatibility level and market presence. This approach ensures that the products listed are not only relevant to the buyer's needs but also established in the market. With AVIA Marketplace's product grid, health care buyers can make informed decisions and select products that meet their specific requirements.

contenders

trailblazers

niche

high performers

LESS
MORE
Match with AVIA Network. To view with a personalized match score, Create an account or sign in.

Stay ahead of the curve with the best digital health newsletter.

Sign up now and join thousands of health system decision makers.

Stay ahead of the curve with the best digital health newsletter.

ad card illustration

Sign up now and join thousands of health system decision makers.

Buyer's Guide


logo
buyer-guide-header

A Buyer's Guide to

Prior Authorization

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.

What is prior authorization?

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.

How digital prior authorization process works

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.
  1. Determine prior authorization requirements. The leading solutions continually scrape payer sites to maintain real-time information on tens of thousands of payer policies.
  1. Complete the prior authorization form. Intelligent prior authorization software identifies and fills out the appropriate prior authorization form based on the patient’s specific payer requirements.
  1. Collect the appropriate documentation. The leading solutions automatically collect and append clinical documentation from the EHR. Staff can review and validate information prior to submission.
  1. Submit the request for prior authorization and monitor for status updates. After staff review and approve the request, it’s automatically submitted through the appropriate web portal. An intelligent dashboard displays real-time status updates.
The case for digital prior authorization
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.


We've seen a steady shift in the industry-the results are undeniable. Health systems are turning increasingly to digital prior authorization solutions that leverage robotic process automation (RPA) to generate, submit, and monitor the status of prior authorization requests. Organizations doing this well are seeing millions of dollars in additional revenue.
Patrick Higley
—Patrick Higley
Vice President, AVIA

What leading digital prior authorization solutions offer

  • 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.
digital prior authorization
Organizing for digital prior authorization
success in your health system


Before implementing end-to-end automation in the prior authorization process, hospitals and health systems must:
  • Have a mature EHR with no planned changes in the near future.
  • Ensure that prior authorization practices are documented and standardized.
  • Obtain organizational buy-in from revenue cycle leadership and operations.
Other capabilities that health systems should deploy to successfully implement digital prior authorization include:
  • Mechanisms to track prior authorization performance at the department and leadership levels.
  • Integration with business systems like EHRs, call center tools and customer relationship management-this eliminates duplication of information and ensures accurate data capture.
  • Strong internal communication to educate staff about prior authorization capabilities and appropriately calibrate responsibilities.
  • Open lines of communication across payer relationship and revenue cycle teams to efficiently respond to procedural changes and resolve problems.
back to top