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Points of Light 2023 Case Study 14
Leveraging HL7 FHIR Interoperability Standards to Automate Prior Authorizations
Author
Boyd Stewart
Author
Aurene Wilford
Managing the prior authorization process is a labor-intensive undertaking that requires significant resources from both provider and payer organizations. This manual process can delay patient access to care and potentially lead to serious adverse events. Beginning with a small pilot, the collaborators in this case study worked with their technology partner to automate the submission of authorization requests from the EMR (including all necessary clinical information) and receive decisions in near real time. The new process has eliminated manual processes, reduced patient wait times, and eased the administrative burden.
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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
Elizabeth Pew
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.