Reduce Denials with Intelligent Automation
Stop preventable denials from slowing down member care. HC Prior Auth leverages AI and NLP to identify and extract the information required to successfully process prior authorization requests such as; procedure codes, ICD-10 diagnoses codes, provider data, etc. This drastically reduces the administrative burden in the intake process and ensures all necessary information is included in submissions – significantly reducing the risk of denials due to missing or inaccurate information.
Navigate Each Step with Data-Driven Confidence
HC Prior Auth guides providers and the Payer’s UM team through the entire prior authorization process. Our platform uses real-time eligibility and medical policy checks to streamline workflows and eliminate confusion by ensuring providers submit the correct documentation the first time, minimizing delays and abrasion created by a manual prior authorization process.
Seamless Bi-Directional Data Exchange
Foster collaboration with providers through HC Prior Auth’s bi-directional data exchange. The platform seamlessly communicates with provider systems to identify if a prior auth is required and collect the necessary documentation from providers, while supplementing the submission process with member data pulled from the Payer’s multi-dimensional longitudinal member record. This reduces the data collection and questionnaire completion burden that often frustrates providers.
Intelligent Automation for Streamlined Workflow
The powerful combination of the CRD and DTR APIs within HC Prior Auth empowers Health Plans to make intelligent decisions and guide providers through the prior authorization submission process efficiently. This reduces administrative burden, minimizes errors, and ultimately expedites member access to necessary care.
Faster Decisions, Improved Member Outcomes
Leverage the power of AI-driven auto-adjudication with HC Prior Auth. Our platform can evaluate low-risk requests based on codified medical policies and the clinical data available, expediting approvals and minimizing wait times for members. This allows resources to be focused on complex cases, improving overall turnaround times and enhancing member satisfaction.
Uncover the Bigger Picture, Drive Better Care
Equip your teams with the full story. HC Prior Auth integrates seamlessly with your existing systems, providing access to a member’s multi-dimensional longitudinal medical record. This holistic view empowers informed decision-making with access to a member’s complete medical history, leading to more effective treatment plans and improved member outcomes.
Reduce Payer Burden with Elimination of “Clinical Bundles”:
Eliminate time spent sorting through clinical bundles – often consisting of hundreds of pages of medical history for one member. HC Prior Auth eliminates the need for providers to submit cumbersome “clinical bundles.” Our platform extracts only the essential information needed for each case, significantly reducing administrative burden on your staff. This allows them to focus on more impactful tasks and deliver exceptional care for your members.
