Authorization Advisor is a generative AI (GenAI)-powered assistant that helps prior auth specialists efficiently submit auth requests on payer portals. The interactive browser sidebar lives in your workflow and enables staff to fill in patient information and authorization details quickly. It reviews relevant medical information and recommends documents to include in the auth request. 

Plus, Authorization Advisor works with any payer portal or service line and most EHRs (including Epic and Cerner). Our AI continuously learns from customer inputs and improves future recommendations.

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.

See below. 

What makes our prior authorization solution unique?

• Efficiently extracting and presenting key information from your EHR in an interactive browser sidebar: Our sidebar connects to your EHR via FHIR integration to access data needed to help auth specialists quickly fill in patient details and accurately attach relevant documentation, speeding up prior auth submissions.
• Intelligently suggesting relevant clinical documentation using powerful generative AI: Authorization Advisor reviews relevant medical information and recommends documents to include in auth requests — providing evidence‐based justifications.
• Seamlessly supports any payer portal or service line, and most EHRs: Stay on top of increasing prior auth requirements and minimize team training by utilizing this integrated and flexible tool designed to handle a higher volume of requests.
• Dramatically supercharging human performance with AI: In a study, AKASA generative AI empowered staff to find 15% more relevant documents than staff alone in auth requests.