Solving The Most Costly Pain Point in Medicine – Prior Authorization
IIC’s 278 authorization solution directly addresses one of THE major and most costly pain points in healthcare for both payers and providers. For payers, IIC’s 278 authorization engine helps automate utilization management by automatically adjudicating the vast majority of PA requests based on the payer’s clinical care guidelines without human intervention. IIC’s 278 authorization engine helps automate utilization management by automatically adjudicating the vast majority of PA requests based on the payer’s clinical care guidelines without human intervention.
Why Informatics In Context is the right solution for your company
Bridging Healthcare’s Digital Divide
Prior Authorization is currently a manual paper-based process that is expensive, inefficient, and administratively burdensome for both payers and medical providers. All payers, including Medicare, must review PA requests based on their own appropriate use criteria and handle time-consuming appeals. Broad adoption of appropriate use criteria requires automated real-time reconciliation of requests based on evidence-based guidelines. Informatics In Context (IIC) is a cloud-based clinical healthcare company that has productized an innovative, touchless, and real-time solution for automating the prior authorization process for payers and providers using EDI 278 which via an ACA mandate, is required for payer adoption by Jan 1, 2016. IIC offers two independent PA solutions that comply with the EDI 278 standard: For Payers, IIC offers its 278 Authorization Engine; For Providers, IIC offers its web portal or integrated web service. These two authorization solutions are completely independent and distinct from each other.
Streamlining Healthcare Processes Brings Efficiency and Cost Savings
For providers, IIC’s portal or integrated web service is an efficient method to submit requests to all payers in the providers network based on a uniform workflow. Its ‘Digital Physician Assistant’ web portal/web service allows providers to automatically check patient eligibility, send referrals to specialists, and submit prior authorization requests for all payer’s in the providers network from a central web-based location, without having to log-in to individual payers sites. Before submissions, prior authorization requests are reconciled against payer policy guidelines to ensure compliance. Benefits include a reduction in payer denials, administrative burden, manual processes, and peer-review consults.
For payers, IIC’s 278 Authorization Engine offers payers an order of magnitude cost savings by maximizing automation, increasing efficiency, and scaling the utilization management function via the EDI 278 standard without increasing administrative staff. It allows the right care to be delivered at the right time for the right reason based on the payers payment policies, clinical guidelines (appropriate use criteria), and reduces the need for time-consuming appeals, medical reviews, and post-service re-adjudication of claims. IIC automates all clinical care guidelines payers use to approve, pend, or deny requests and looks up the correct choices based on the payers guidelines. Payers are able to internally update and edit rules as they change. It ensures payment for the most cost effective and medically necessary treatment.
User Simplicity for Optimized, Efficient Workflow
The user interface is designed from the provider’s perspective for simplicity, streamlined workflow, and ease-of-use. It optimizes administrative simplification and increases user efficiency. Pre-populated selection fields provide users the most efficient way to submit requests to payers in the shortest amount of time, with the fewest possible clicks. All the appropriate clinical information needed for submission by the payer including the list of CPT codes, HCPCS codes, ICD codes, appropriate use criteria, and payer-specific clinical policies are automatically presented.