Prior authorization is a complex process by which payers determine the clinical appropriateness of procedures, prescriptions, and referrals. However, the current process is a significant drain on an already strained U.S. healthcare system costing between $23 and $31 billion a year. This is a big problem to tackle as it involves providers, payers, and patients.

Specifically, health plans are currently spending valuable time and resources manually reviewing authorizations, which is a time-consuming process that can delay treatments – or worse, be an obstacle to care. Not only this, but with manual reviews estimated costs between $20 to $50 per prior authorization clinical review, health plans are looking at ways to automate and reduce the amount of unnecessary reviews being done.

Three significant barriers exist around prior authorization:

1. The lack of standardized criteria for submitting prior authorization requests across payers
2. The lack of consistent data needs
3. The lack of integration between clinical and administrative systems

These obstacles, along with a general resistance to change the status quo, have kept the industry from improving the prior authorization process …but Apixio has a novel solution with the power of AI.

Check out our latest whitepaper, Solving the Prior Authorization Problem With AI, to:

1. Understand the current challenges payers are facing with prior authorization
2. Digg deeper into how these challenges may impact your organization
3. See how Apixio is addressing these challenges with AI

Download the Whitepaper.