Highlights
- Slow and non-standardized communications are key factors that make the prior authorization process painful for providers.
- Payers can proactively alleviate some of the pain for providers and improve network relationships.
- A unified communications system can address prior authorization issues and improve results for patients, providers, and payers.
Rapid digitization and automation of healthcare have provided many benefits to healthcare providers, including cost efficiency, better preventative care, and improved patient outcomes. However, the prior authorization process for certain types of care remains a tedious, costly, and painstaking process.
Insurers require prior authorization for expensive procedures that may or may not fall under the category of medical necessity. The timeline for a response is often much longer than providers or patients prefer.
The following is an overview of the provider pains associated with prior authorizations and how healthcare payers can use an all-in-one communications platform to ease that burden.
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Why the prior authorization process is painful
Although providers might prefer that the prior authorization process go away, payers know that is not likely to happen in the near future. Even if all payer organizations were open to that idea, government regulations prevent it.
What providers really want is for insurance companies to recognize and react to the most common sources of pain, including the following.
Too many requests
One of the biggest causes of prior authorization pain for providers is simply the volume of requests. When insurers feel pinched by health costs, they tend to tighten the reins on spending. By requiring prior authorization, insurers hope that the paperwork deters providers from recommending expensive procedures that aren’t necessary.
However, a request for preauthorization essentially amounts to an area of distrust between the insurer and the provider. The insurer doesn’t trust the provider to make the right decision in consideration of both patient outcome and cost. Some insurers have begun implementing systems whereby providers that demonstrate effectiveness in only making requests when necessary face reduced demands for preauthorization.
Slow communications
The communications process is often very slow between the provider and the insurer. Providers submit the request, but insurers often want additional information or need to clarify certain points before approving the request. This back-and-forth can add days or weeks to the decision timeline.
Non-standardized electronic communications and approval processes
At this point, most insurers have non-standardized processes for requests. Additionally, there are significant differences in request processes from one insurance payer to another. This lack of standardization contributes to the noted delays in the decision process.
The lack of consistency from one insurer to the next makes it difficult for providers to get familiar with expectations. The uncertainty of expectations leads to incomplete or incorrectly submitted requests.
How a unified communications system can help
Providers don’t control the requirements insurers have for preauthorization, so it is largely up to insurance companies to find ways to reduce the pain associated with preauthorization. One of the first and most impactful steps to take is the adoption of an all-in-one digital communications system.
The following is an overview of several ways insurer adoption of a unified communications system can alleviate preauthorization pain for providers.
Instant communication
A top UCS allows for efficient communication, including one-click messaging across various communication methods. The insurer or provider, for instance, could initiate quick communication to clarify uncertainty about request requirements, share missing details from a request, or follow up on a pending request.
This type of rapid interaction platform allows for much swifter processing than conventional phone methods that include the universally dreaded, so-called “phone tag” and that can take days to reconcile.
Conversation records
A top UCS includes methods for recording interactions. An insurer could use recorded interactions to review previous issues in prior authorization processes. Doing so allows payers and providers to uncover common obstacles or concerns to review and fix.
Automation of prior authorization tasks
One of the most powerful things an insurer can do to minimize the burden of prior authorizations on providers is to automate tasks that have been completed manually. Certain steps in the approval process are consistent enough that automation is possible.
Automating these steps may mean that a request is submitted much faster than it might be if a doctor is busy and completing tasks manually. It also potentially allows for faster resolution of common issues if providers don’t have to engage with the insurer each time a problem comes up.
If payers can effectively reduce provider frustration with prior authorizations, there are many benefits for all network parties. The time savings and efficiency gains mean lower costs for payers and patients. Additionally, more efficient preventative care and screenings would lower the burden of expensive, intensive treatments. Every party involved would experience less pain.
Let RingCentral power your prior authorization processes
The purpose of prior authorizations is to protect insurers from paying for unnecessary, expensive procedures. However, the process negatively impacts providers and patients when procedures are not only necessary but time-sensitive as well.
Many of the inefficiencies in the prior authorization process can be streamlined with effective communication. Insurers can improve the timeline from request to approval by investing in an all-in-one digital communications solution.
The RingCentral unified communications system enables communication efficiency across all popular platforms. It allows providers and insurers to work more closely to speed up decisions and ensure accurate information is used. See how cloud communications can transform your healthcare organization. Request a demo.
Originally published Jul 05, 2022