Prior Authorization vs Prior Authorization

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Prior Authorization

5.0

1 review

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Product Description:

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.

About Janus Health:

Janus Health is fundamentally transforming the future of revenue cycle work with our groundbreaking end-to-end artificial intelligence platform. Our rich history in healthcare and technology allows us to instinctively understand what it is about revenue cycle management that creates significant challenges for healthcare organizations. We’ve developed Operational Intelligence and Intelligent Automation solutions to aid revenue cycle teams in optimizing their workflows, so they can do more with less and ultimately collect more cash.

Product Description:

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

About Waystar:

Waystar delivers innovative technology that simplifies and unifies healthcare payments. The company’s cloud-based platform helps healthcare providers across all care settings streamline workflows, improve financial performance and bring more transparency to the patient financial experience. Waystar solutions have been named Best in KLAS or Category Leader by KLAS Research 16 times (across multiple product categories) and earned multiple #1 rankings from Black Book. The Waystar platform is used by more than half a million providers, 1,000 health systems and hospitals, and 5,000 payers and health plans—and integrates with all major hospital information and practice management systems. On an annual basis, Waystar’s AI-powered solutions process $5B in patient payments, generate $4B in out-of-pocket estimates and process claims representing approximately 40% of the U.S. patient population. For more information, visit www.waystar.com.

Compatibility level

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Clients

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Product Capabilities

Requirements Identification

An unattended automation is initiated from the EHR, determines whether an auth is required, and returns the response to the EHR. From there a user can initiate the submission workflow, if needed.

Requirements Knowledge Base

We leverage real-time automations instead of relying on a quickly outdated rule library, allowing us to keep up with the payer landscape and prior authorization changes. We can develop some client-specific rules per automation.

Request Submission

Leveraging Janus Health Teleport, Prior Authorization automates navigation to the authorizing payer or portal to the point where human intervention (clinical documentation upload and submission) is required.

Status Monitoring

An unattended automation checks the status of submitted authorizations and returns it to the EHR.

Use Cases

Description:

Prior Authorization automates auth determination at scheduling, so patient access staff only touches those accounts requiring authorization submission.

Pediatric use cases:

None provided

Users:

Patient access specialist

Description:

With over 300+ payers and a broad array of deployable service lines and patient types, we provide a full cycle automation solution for prior authorization: from pre-scheduled prior auth submission, status checking and denial prevention worklist alerts, as well as medical necessity verification and notification of admission.

Pediatric use cases:

None provided

Users:

Pre-service financial clearance teams, auth cert teams, any prior authorization staff doing medical necessity as well as authorization for services at acute care facilities or OP areas.

EHR Integrations

Integrations:

Acute care EMR

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

Epic

Hardware Compatibility:

None provided

Integrations:

None provided

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

None provided

Hardware Compatibility:

None provided

Client Types

Pediatric Hospitals

Academic Medical Centers

Large Medical Facilities

Extra Large Medical Facilities

Pediatric Hospitals

Academic Medical Centers

Accountable Care Organizations

Rural Hospitals

Small Medical Facilities

Large Medical Facilities

Medium Medical Facilities

Extra Large Medical Facilities

Differentiators

Differentiators vs EHR Functionality:

Broad payer and specialty coverage, driven by providers' needs (not payer sponsorship)
>80% of payer mix
Teleport streamlines auth initiation

Differentiators vs Competitors:

Broad payer and specialty coverage, driven by providers' needs (not payer sponsorship)
>80% of payer mix
Teleport streamlines auth initiation

Differentiators vs EHR Functionality:

Many hospitals, health systems, and IDNs have invested in billion dollar EMR/EMRs which are an extraordinary vehicle for clinical and billing functions -- but lack the ability to elevate automation in key business areas such as prior authorization. This is due to their lack of payer connections and the absence of advanced intelligent software. Together, Waystar brings the intelligence that powers today's EMR/EHR platforms and automation efforts.

Differentiators vs Competitors:

With nearly a decade in the business of automating prior authorizations, we are known for our internal expertise when it comes to payers, process change, and technology. We believe pushing the envelope in know-how across all 3 is what gives our clients the edge on automation. With more payer connections, more relationships with payers, and greater flexibility in accessing payer data we can access the best and most timely data. We not only seamlessly integrate with EPIC but offer full-stack integration capabilities or a powerful stand-alone application -- all because each patient access team is different. And powered across our Hubble platform (a blend of RPA, machine learning, NLP, and advanced auth rules) we are well positioned to power your automated enterprise.

Keywords

prior authorization,intelligent automation,automated authorizations,automated workflows,employee experience,patient experience,operational effiency,payer portal navigation,ehr integration

automation,intelligent automation,prior authorization,ai,rpa,operational effiency

Images

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Downloads

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Company Details

By Janus Health

By Waystar

Founded in 2000

Visit Website

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