Case Study: Easing Healthcare Preauthorizations - Priority Health
New Authorization Portal speeds approvals and boosts provider satisfaction
Easing Healthcare Preauthorizations with a New Authorization Portal
Priority Health and GuidingCare® have teamed up to tackle the common pain points in healthcare preauthorizations, delivering a solution that significantly streamlines the approval process and improves provider satisfaction. This collaboration has led to the development of a new Authorization Portal, which has been instrumental in easing preauthorization burdens for Priority Health's extensive network of healthcare providers.
The Challenge and Partnership
Serving over a million health plan members and accounting for 97% of Michigan’s primary care practices and 96% of its hospitals, Priority Health faces a high volume of preauthorization requests—up to 3,500 weekly. To address this, Priority Health partnered with GuidingCare in 2019 to develop an efficient authorization portal.
Key Features of the Authorization Portal
- Submit Preauthorization Requests Electronically: Streamlining the submission process.
- Track Request Status in Real-Time: Providing immediate feedback on preauthorization requests.
- Attach Documentation and Images Easily: Ensuring all necessary information is included with one-click links.
Success and Implementation
The Authorization Portal went live in 2020 and has been a huge success, now enabling nearly immediate electronic responses to preauthorization requests. By leveraging leading medical guidelines and automating workflows, the system reduces administrative burden, standardizes processes, and offers predictable approval outcomes.
Impact and Benefits
The renewed process has brought significant improvements:
- Efficiency Gains: Reduced administrative tasks and quicker response times.
- Predictability: Providers can better anticipate approvals and denials, enhancing evidence-based care.
- Reduction in Concurrent Reviews: The portal minimizes the need for daily phone calls during inpatient stays by allowing extensions directly through the portal.
- Data-Driven Decisions: The platform provides valuable data insights, helping Priority Health make informed decisions on the necessity of preauthorizations.
Ann Donnelly from Priority Health highlights the drastic improvement in turnaround times, now under three days, with an estimated 80% of requests auto-approved electronically. This efficiency reduces friction between providers and health plans and mitigates member uncertainty and anxiety.
Conclusion
The collaboration between Priority Health and GuidingCare demonstrates the power of innovative solutions in simplifying healthcare processes. The new Authorization Portal not only makes preauthorizations more manageable but also sets a precedent for future advancements in healthcare technology. For more details on how this groundbreaking tool can benefit your organization, learn more about easing healthcare preauthorizations with Priority Health and GuidingCare.
