Prior Authorization

In today’s rapidly evolving healthcare landscape, optimizing revenue cycle management (RCM) in healthcare is paramount for providers aiming to maintain financial health while delivering exceptional patient care. However, traditional RCM solutions suffer from glaring inefficiencies that lead to frustrated patients and lost revenue. Enter the digital front door (DFD)—a holistic approach that enhances RCM by digitizing and centralizing various aspects of the patient journey. By streamlining everything from intake to bill pay, the DFD drives efficiency and addresses many of the shortcomings of traditional RCM along the way.

AVIA Marketplace's Top Revenue Cycle Management (RCM) Companies Report | Fall 2024

Digital RCM solutions are software platforms and technologies that automate and optimize the healthcare revenue cycle. These tools leverage advanced algorithms, artificial intelligence, and data analytics to streamline financial processes, improve efficiency, reduce errors, and provide actionable insights.

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.

The Top Digital Prior Authorization Companies Report is intended to provide healthcare leaders with a broad view of the prior authorization process and showcase standout companies and solutions with proven market traction. Users can view quick summaries to help them identify which solutions might meet their needs and visit AVIA Connect to access detailed profiles and verified client lists, compare solutions, and generate Match Scores to narrow their selections.

With its end-to-end automation platform VALER, Voluware offers a unified solution for prior authorizations, referrals management, and eligibility and coverage. VALER fully automates prior authorization submissions and includes a comprehensive form library and real-time payer information and status monitoring. The cloud-based solution covers all service types, including professional, facility, technical, pharmacy, and DME authorization workflows, and creates a centralized communication hub to capture faxed medical necessity documentation and phone exchanges with payers.

Prior authorization, or PA, remains a massive administrative burden for health plans and their provider partners, and often delays patient care. It also represents an untapped opportunity to improve patient care journeys and enable more successful value-based care arrangements. The Cohere Unify™ solution suite automates prior authorization intake and decisioning to drive administrative efficiency, while adding clinical intelligence to speed and improve patient outcomes.

At Arrive Health, the patient-provider relationship is our true north. Our solutions leverage accurate, patient-specific data to help providers reach the best decisions with their patients. With real-time notifications for coverage restrictions and prior authorization details, as well as automatic initiation of the electronic prior authorization (ePA) process, providers can significantly reduce administrative burden and ensure transparent communication with patients and care teams. Our directly connected network combines real-time prescription benefit data (from payers and PBMs) with automated ePA capabilities to reduce provider burden, improve patient engagement, and speed time to therapy.

Change Healthcare is focused on enabling a better, more efficient healthcare system through the power of the Change Healthcare platform. Our goal is to help payers, providers, and consumers improve clinical and financial outcomes so that everyone in the healthcare system can thrive. Despite all the automation innovations that exist today, authorization automation remains a complex challenge. Although the industry has recognized some success, many gaps still exist that require costly human intervention. The manual nature of prior authorization, the need for clinical documentation, and payer connectivity are some of the challenges Change Healthcare is solving today.

AVIA Marketplace's Top Prior Authorization Companies Why prior authorization matters What leading solutions offer AVIA Marketplace’s top prior authorization companies

Recently, I had the privilege of attending the AHA Rural Health Conference, a gathering that brings together healthcare professionals, administrators, and advocates from across the nation to address the unique challenges and opportunities within rural healthcare. The experience was not only enlightening but also deeply inspiring, highlighting the resilience, innovation, and dedication of those at the forefront of rural health. Reflecting on the conference, I’d like to share three key themes and takeaways that resonated with me, in the hope of offering some insights and encouragement to others navigating this vital field.