Automated Prior Authorization Processing System to Reduce Manual Workload

The healthcare organization faces overwhelming manual prior authorization processes that are time-consuming, error-prone, and resource-intensive, leading to staff burnout, delayed patient care, and revenue cycle inefficiencies. The existing workflow involves multiple manual logins and data entry tasks across EHR systems and payer portals, hindering operational efficiency.

A mid to large-sized healthcare provider or healthcare system experiencing high volumes of prior authorization tasks seeking automation to improve efficiency.

• Achieve at least a 90% reduction in manual prior authorization workload through automation.
• Increase process speed and accuracy to 100%, eliminating manual errors.
• Redirect staff resources from routine tasks to more value-added revenue cycle activities.
• Improve overall operational efficiency and reduce turnaround times for prior authorization approvals.

• Automated login and navigation to EHR and payer portals
• Data extraction from EHR (including HCPCS and ICD10 codes)
• Automatic lookup and verification of prior authorization requirements within payer portals
• Data entry automation for patient details and authorization information
• Real-time monitoring and reporting of process status
• Fail-safe mechanisms for exception handling and manual override capabilities

• EHR systems for patient data extraction
• Payer portal systems for authorization lookup and submission
• Secure data transfer protocols for protected health information (PHI)

• System uptime of at least 99.9%
• Processing speed to enable near real-time authorization handling
• Compliance with healthcare data security regulations (e.g., HIPAA)
• Scalability to handle increasing authorization volumes without performance degradation

The automation system is expected to reduce manual prior authorization workload by over 90%, significantly decreasing processing times, minimizing errors, and enabling staff to reallocate efforts toward more strategic revenue cycle activities. These improvements aim to enhance operational efficiency, improve patient care timeliness, and stabilize staffing requirements in resource-constrained environments.