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Points of Light 2024 Case Study 16
Using FHIR Standards to Streamline Prior Authorization Management & Improve Patient Care
Author
Boyd Stewart
Author
Aurene Wilford
The manual nature of prior authorizations creates an administrative burden for provider and payer organizations and delays patient access to care. The stakeholders in this collaboration worked to automate the prior authorization process by using Availity to connect the payer and provider solutions, allowing data to be exchanged more seamlessly. This project led to a faster turnaround time for prior authorization approvals, a reduced administrative burden, and improved access to care for patients.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Replicate?
- What's Next?—Vision for the Future
Writer
Natalie Hopkins
Designer
Jess Wallace-Simpson
Project Manager
Joel Sanchez
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.