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Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Awards
Differentiators
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Media
Company details
Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Awards
Differentiators
Keywords
Media
Company details
Digital Clinical Assistant (DCA)
Digital Clinical Assistant (DCA)

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Categories

Solutions

Description

Product Description:

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.

About Digital Blue:

Digital Blue is a healthcare consulting and solutions company focused on improving lives through optimized business performance. Our services and solutions empower leaders across the healthcare ecosystem to eliminate inefficiencies, increase productivity and improve patient satisfaction. Client benefits include; increased revenue, reduced operational cost and administrative burden, and improved quality of care. 

Product Description:

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal.

All built just for you.

About Valer:

Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal.

All built just for you.

Valer's automation technology enables our clients to reduce labor cost, claim denials from avoidable prior authorization errors, and writeoffs stemming from denials. With prior authorization approvals further in advance of scheduled treatments and procedures, Valer enables fewer rescheduled and abandoned appointments. Patients are happier, providers are happier, and staff are happier.

Compatibility level

Select which hospital or health system you work at and see a personalized compatibility level.

Clients

Select which hospital or health system you work at and see the client list

Product Capabilities

The DCA will gather all information from the open prior auth request, including reading the ePA portal key from faxes or digital documents attached to the prior auth request. The DCA uses APIs to retrieve data such as demographics, lab results, and medication history. The DCA executes business rules and submits the initial request in the provider's configured workflow. The DCA also updates internal notes with the ePA key, making navigation between ePA portal and the EMR easier

Prior authorization requirements knowledge base is continually and automatically maintained with minimal effort required outside of the clinical team outside of weekly check-ins to verify all clinical questions are being answered as they would (continuous quality improvement).

The digital worker entirely automates form completion via API access. Appropriate fields are populated by leveraging structured and unstructured data from the EHR.

DCA and its components are a secure, Microsoft Azure Cloud-based infrastructure.

Necessary documentation can be attached to satisy the prior authorization request via APIs

Prior authorization requests can be submitted on behalf of the health system through e-fax, payer portals, their party sites, etc.

Prior authorization request status is monitored in near real-time. It can be pushed back, along with other relevant information (e.g., tracking numbers, supporting text), into the appropriate work queues and fields within the EHR. Exceptions-Only processing is done by the clinician - ie: only clinical questions the the DCA is not configured for will be sent back to the clinical team.

Valer can be configured to identify highly targeted information regarding authorization requirements and/or services which are "no auth required." Valer has the ability to work with select payers to provide authorization requirements, "no auth required" alerts, and authorization submissions via real-time APIs (application programming interfaces) where available.

Valer comprehensively automates completion and submission of prior authorizations for 1,000+ unique payer fax forms and 75+ payer web portals.

Valer's form library maintains and updates over 1,000+ payer authorization fax forms across all service lines (diagnostic imaging, surgeries, procedures, chemo/infusion, medications, notice of admissions, DMEs, sleep, Worker's Comp). Valer's proprietary technology can add any new fax form for users typically within 24 hours to support authorizations and referrals.

Valer provides the ability for users to easily attach any relevant clinical documentation to a prior authorization for submissions. Valer supports various file formats needed for submission. Valer also captures documentation from payers regarding approval tracking codes, expiration dates, units of service, CPTs approved, which can be pushed directly back into EHRs/practice management systems to avoid manual data entry. Valer also has Epic's x275 clinical document exchange functionality live in production to directly exchange information from Epic to Valer and back.

Valer comprehensively SUBMITS prior authorizations across both fax and web portal modalities across all-payers and all service types. Valer provides ONE interface, deeply integrated with EHR workflows to automate both today's manual authorization submission and verification workflows.

Valer provides automated authorization status verification across 75+ payer web portals. Authorization information (tracking numbers, units, expiration dates, sites of service, CPT/family of codes approved can be automatically pushed back into EHRs in an automated process further eliminating the need for manual data entry.

Use Cases

Description:

The Challenge

  • Prior authorization is the most burdensome process for many providers
  • The number of procedures, drugs & DME requiring prior authorization continues to grow
  • Payers, providers, and CMS do not utilize common prior-authorization rules, standards, documentation, or processes –this causes up to 80% of initial prior authorization denials
  • Manual prior authorization processes are getting costlier due to additional administrative burdens.
  • Many delays in patient care are directly related to prior authorization delays and data entry errors, resulting in risk to the patient and questions from them and their families.

The Solution

  • Centralized prior authorization work-bench with optimized workflows, case tracking, and reporting
  • Automated retrieval of the most up-to-date formularies and prior auth guidance by payers
  • Automated gathering of disparate data and documents for consolidation and initial fulfillment of prior authorization requests
  • Real-time, intelligent notifications and tasking for prior authorization team to ensure efficient exception processing
  • Built-in assistance for prior authorization nurses through the centralized workbench
  • Exception-only involvement of prior authorization team, guiding to improve the initial prior authorization submittal process in the future.

The Benefits

  • Reduce prior authorization costs by up to 60%
  • Reduce the decision time on prior authorizations by up to 50%
  • Provide hundreds of hours per year back to nurses to provide quality care, as opposed to prior authorization administrative tasks
  • Increase the rate of first-pass approval of prior authorizations by up to 50%
  • Decrease patient’s likelihood of abandoning care due to frustration or inconvenience
  • Retain the familiarity of your EMR for physicians while streamlining the process for nurses
  • The DCA requires no changes to your existing EMR system
Pediatric use cases:

No modifications to the workflow are necessary for pediatrics

Users:

FQHCs, Primary Care, Mult-Specialty Physician Groups, Hospital Clinics, Physician Groups, Medical Group Practices, Independent Medical Practices, Telehealth providers, Ambulatory Surgery Centers, Urgent Care Centers, Hospitals, Pediatricians, Dermatologists, Endocrinologists, Gastroenterologists, Cardiologists, OBGYN, Community Health Centers, Rural Hospitals, Non-Profit Hospitals, Specialty Group Practices.

Description:

Valer provides health systems, hospitals, and ambulatory clinics with one place to streamline, automate, and manage today's manual prior authorization workflows. Valer saves time, cost, and reduces patient access denials and avoidable write-offs.

Pediatric use cases:

Pediatric health systems and clinics utilize Valer to reduce the time and cost involved with today's manual prior authorization and referral workflows.

Users:

patient access teams, ambulatory clinic authorization teams,  admitting/scheduling teams, revenue cycle teams

EHR Integrations

Integrations:

Ambulatory EMR, Patient portal

EMR Integration & Relevant Hardware:

Use case dependent

EMRs Supported:

athena

Hardware Compatibility:

Not applicable

Integrations:

Acute care EMR, Ambulatory EMR, Community based organizations, ADT, Access +/or revenue cycle, Website / public online sources

EMR Integration & Relevant Hardware:

Recommended, but not required

EMRs Supported:

Epic, Cerner, Allscripts, NextGen, athena, GE, Athenahealth, Other

Hardware Compatibility:

Desktop

Client Types

None provided

Awards

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Differentiators

Differentiators vs EHR Functionality:

Prior Auth Process As-Is

Prescriber opens the EMR and prescribes the prescription.

The pharmacy will notify the prescriber that a prior auth is needed

Prescriber will submit an electronic request for prior authorization through ePA or insurance portals

Prescribers and their staff input patient demographic information and history and answer clinical questions as they come in. 

The staff is constantly checking for status updates

Duplicate requests come in, typically at night and over the weekend. If the PA request isn't completed quickly enough, these must be filtered out manually.

Backlogged workbaskets and data-entry errors cause care gaps and delays in treatment.

Increased administrative burden is the number one cause in provider burnout and a significant cause for loss in revenue

DCA Optimized Prior Auth Process

The Clinician Opens the EMR and prescribes the medication

DCA monitors the EMR and other systems for PA work and kicks off the automated process

DCA auto-triages PAs and removes ALL duplicate requests as they come in

DCA auto-fills forms via APIs and submits the requests for medications it has been configured for based on your practices' volumes

DCA creates a work queue for any encountered exceptions

nurses work only the PA requests or clinical questions that the DCA is not configured for, saving time for high-value work

Based on payer rules, the DCA posts status updates/tasks to EMR and auto-updates status

60% reduction in manual effort

50% improvement in time to approval

100% elimination of duplicate requests

See more patients, improve employee satisfaction/retention, and get home on time!

Differentiators vs Competitors:

None provided

Differentiators vs EHR Functionality:
  • Single platform and payer portal consolidates payer management
  • Comprehensively submit, verify, manage prior authorizations and referrals
  • All payers and service lines
  • Continuous real-time payer updates
  • 2-way data integration with EHR systems
  • Real-time workflow visibility and reporting
  • Integrates with any EHR or billing system for seamless workflow
  • Clients using Epic, Cerner, Veradigm, Athenahealth, NextGen and more
Differentiators vs Competitors:
  • Valer focuses exclusively on automating submissions, status-checking, and verification with all payers- national, regional, local
  • Valer supports every service type, specialty, and care setting except formulary medications and dentistry
  • Valer integrated bi-directionally with any EHR or system of record

Keywords

Images

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DCA Patient Care with a Heart

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Valer Reporting Screen Shot.png

Videos

1 of 1

dca_priorauth_short (1).mp4

1 of 2

Valer Explainer Video_Final.mp4

Downloads

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DCA-for-Prior-Auth-2 (1).pdf
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VALE144-Glossary_v7.pdf

Alternatives

Company Details

Founded in 2010

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