Perfecting Prior Authorization (PPA) Using Human & AI Approach

Healthcare COOs and patient access leaders can leverage Perfecting Prior Authorization (PPA) to assess their current prior authorization metrics against MGMA benchmarks for:

Medical Necessity Check

Target <3% denials to meet MGMA standards.

Service Location Compliance

Ensure <2% denials on the place of service.

Quick Authorization Approvals

Aim for 5-7 day turnaround on approvals.

Duplicate Services Control

Keep duplicate service denials below 1%.

Frequency Limit Adherence

Limit frequency of service denials to <2%.

Resubmission Efficiency

Achieve a >70% success rate in resubmissions.

How Can You Perfect Prior Authorization?

Evaluating Critical Aspects

Assess staff efficiency in handling PA requests.
Identify delays in approvals impacting care.
Review denial rates for continual improvement.

MGMA Benchmarking

Compare denial rates with MGMA's <5% goal.
Measure approval times against MGMA standards.
Align PA process costs with MGMA metrics.

Regular Reporting

Monthly audits to track PA process efficacy.
Generate real-time auth application updates.
Analyze trends to foresee and mitigate denials.

AI-Enabled AR Analytics

AI predicts likely denials for preemptive action.
Automate data entry to reduce human errors.
Use AI to comply with payer-specific rules.

What do you get from the PPA?

Standardize Processes

Implement standardized processes for submitting prior authorization requests to reduce variability and errors.

Predictive Analytics

AI can predict which prior authorization requests are likely to be approved or denied, allowing for proactive adjustments.

Natural Language Processing (NLP)

NLP helps in understanding and processing clinical documentation, improving the accuracy of prior authorization requests.

Real-Time AI Decisions for Prior Authorization

Real-Time Decision Making

AI systems can make real-time decisions based on payer guidelines, reducing delays in the approval process.

Perfecting Prior Authorization (PPA) in Your Revenue Cycle

Streamline your pre-revenue cycle efficiency with perfecting prior authorization (PPA): Enhance patient care and reduce delays with our advanced, technology-driven prior authorization methods.