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

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

For hospitals, it is 4x harder to collect from patients than insurance payers. Patients now make up to 30% of hospital revenue but are 4x harder to collect from than insurance payers1 due to complexity, regulation and patient means. 

Sift Healthcare provides advanced analytics and machine learning integrations to optimize patient payments. Sift combines patient payment expertise and AI-driven intelligence to equip providers with an integrated toolset to optimize patient financial engagement.

Patient collections should be a dialogue, not a solicitation. Sift integrates AI into your patient engagement platform to guide patient communications activities – maximizing collections while improving patient engagement.

• Account Segmentation
• Patient Contact Strategy
• Payment Plan Provisioning
• Improved collections, increased payment plan adoption, and reduced inbound/outbound calls

Propensity-to-pay for a person, not a number. Sift goes beyond credit scores, leveraging historical data to determine the best engagement approach for each patient.

• Improved Patient Satisfaction
• Pre-service patient financing and collection recommendations that help avoid surprises and set expectations
• Lookalike predictive models, not credit scores and rule logic
• Increased upfront collections with more empathy

Sift Healthcare provides intelligent and accessible solutions for provider systems that need to extract meaning and value from their vast stores of payments data. Sift organizes and normalizes all of your payments data in one location, providing a holistic view of collections. Our denials and patient collection dashboards, payer scorecards, propensity to pay tools, market intelligence reports and enriched patient profiles enable revenue cycle teams to optimize workflows and accelerate cash flow.

• Unified and normalized data sets that are accessible and provide a full view of patient payment behavior 
• Dynamic machine learning based workflows, rather than rigid rules-based logic
• Intelligence that enables the most effective use of EHR functionality