Best Prior Authorization Products

HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.

Gone are the days of illegible, incomplete, inaccurate faxes sent back and forth between the physician’s office and the facility’s scheduling department. The cumbersome and error prone faxing process is replaced by an electronic form that is configured to each facility’s exact specifications and reacts to the user’s input thereby assisting the physician’s office in getting it right the first time.

All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.

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.

This solution automates the process of checking requests under review as well as continued status changes and updates. It supports many portals such as Evicore, Magellan, UHC and others. The solution includes business rules, exception handling and daily reporting functionality with customizable dashboard views. AI is also used to do analysis and supply predictive capabilities. The solution can also be hosted and supported by CampTek as an ongoing managed service.

• Cohere Unify™ Intake: Digitizing and improving intake across fax, EMR, and portal
• Cohere Unify™ Decisioning: Prior authorization check, completeness scan, automated clinical review, and pended review pre-processing
• Cohere Unify™ Review: Queue management, AI-assisted manual review, and letter generation

Patient access departments are charged with accuracy from the start. 

Challenges—claims denials, returned mail, regulatory burdens and low patient satisfaction—are barriers they face. Solutions that empower registrars and staff with intuitive, consistent workflows and that prepare patients for their financial obligations have been elusive—until now.

True Access™ clearly and accurately fills the gaps in preservice coverage verification and estimation of patients’ financial obligations. Staff gain consistent workflows and patients receive precisely tailored payment options everywhere. True Access includes additional patient access tools for staff to support eligibility and address verification, medical necessity and prior authorization processes.

With True Access from RevSpring, you receive proven solutions that support four critical areas: 

(1) Coverage Determination and Verification,

(2) Claim Denial Prevention,

(3) Patient Financial Readiness and Increased

Collections, and

(4) Tools, Workflows and Reporting for Staff.

Coverage Determination & Verification

Fast, simple and accurate resolution of all patient accounts prior to, or at the point of, service—no matter whether or not patients are insured, uninsured, underinsured and/or qualify for financial assistance. Includes Eligibility, Coverage Verification and Determination, and Medicaid Coverage Discovery.

Claim Denial Prevention

True Access reduces time spent rebilling claims and reduces days in AR by submitting claims correctly from the start. Includes Prior Authorization and Precertification, Medical Necessity and Coordination of Benefits.

Patient Financial Readiness & Increased Collections

Prepare patients for their financial responsibility and empower them to pay precisely what they can, when they can, from anywhere. Accurate estimates, seamlessly 

integrated with RevSpring’s PersonaPay portal, enable patients to manage their balances with confidence. Our hassle-free billing adjustment solution also allows 

providers to confidently request payments in advance.

Tools, Workflows & Reporting for Staff

True Access empowers staff with intuitive workflows and a modern user interface to manage registration quickly and efficiently. Intuitive staff views based on work queues and guided workflows drive consistency and accuracy, saving time for patients and staff. Our tools also allow you to monitor staff performance.

Direct is the leading EHR-integrated cost transparency solution. The solution brings real-time, pharmacy benefit cost information, coverage restrictions, and alternatives into native EHR workflows. Giving providers cost information at the point-of-care enables data-driven and evidence-based decisions that help patients get the care they need at prices they can afford.

Features and Benefits:

 - Access to lower-cost alternatives increases care adherence and patient health and satisfaction

 - Select medications that do not require prior authorization

 - Reduced pharmacy/PBM/payer call-backs, prior authorization denials, and other uncompensated provider hassles

 - Uses native order workflows, is easy to implement

- Surfaces pharmacy alternatives to drive continuity of care and patient satisfaction

- Integrates patient affordability program offerings into RTPB results, showing best-cost options when insurance coverage isn't found or doesn't apply. 

Lose the work your heart's not in!

Whether you're a payer processing claims forms or a provider charting during your off hours, the administrative burden in healthcare is high. But when the work you want to do is buried under the work you have to do, don't lose heart.