Understanding the prior authorization dilemma 

The prior authorization process has always been a hurdle in the billing process, creating inefficiencies that adversely impact patient care and burden physician practices. In fact, with physicians often facing delays and denials due to the complex authorization requirements imposed by insurance companies, more than 72% of resources complained of experiencing huge stress and burnout. 

While Prior Authorization is an essential aspect of healthcare systems, we also know it is not without its complications. Thus it is best to recognize the challenges inherent in PA and adopt innovative solutions that not only improve the process, and reduce administrative burdens, but further ensure timely, quality care for their patients. 

Understanding the prior auth challenges: 

69 percent of physicians experienced wait times of several days, and 10 percent faced wait times exceeding a week. Additionally, 86 percent of respondents reported an increase in prior authorization requests and supporting documentation requirements from health plans which managing it was quite a mess. 

 In fact, the authorization problems do not end here with the evolution of the healthcare industry and more drugs formation, the number of insurance plans is increasing as well, each with its own forms and policies. This makes it difficult for providers to keep up with the requirements which keep changing. This is why here are a few pointers that might be a big help: 

Familiarize Yourself with Payer Guidelines: a person handling the authorization must be well-versed in the coverage and preauthorization guidelines of each payer. in fact, providing specific diagnoses on reports further helps demonstrate the medical necessity of the procedure and supports the authorization request. 

Adhere to Recommended Treatment Guidelines: Physicians should ensure they follow recommended treatment guidelines before ordering high-cost procedures. Aligning treatments with evidence-based practices strengthens the case for medical necessity and ensures faster authorization. 

Meet Payer Criteria: Prior to submitting a prior authorization request, providers should ensure they meet all the payer's criteria and required conditions. Adhering to the requirements and providing necessary documentation improves the chances of the approval rate 

stay updated constantly: Frequent monitoring of insurance carrier websites enables providers to stay informed about any kind of changes or issues that may impact patients and in order to ensure the following of the correct pre authorization process. In fact, as insurance companies update their coverage policies periodically, providers must further stay informed about these changes and update their contracts accordingly to maintain coverage. 

To address the challenges associated with obtaining preauthorizations, physicians today when the healthcare cost is rising having specialists who have extensive experience navigating the process and can communicate with insurance companies and access prior authorizations efficiently can help a lot. in fact, Partnering with experts like Sunknowledge Services Inc for your pre auth further minimizes the time and resources required, reduces denial risks, and benefits both physicians and patients. 

Reducing the stress and burnout about you all ensuring 100% authorization submission on the same day along with working on improving the authorization rate by 1.5.-2x, Sunknowledge offers the highest productivity metrics which no other RCM organization can. 

 Simplifying and improving the prior authorization process Sunknowledge today is known for more efficient and effective healthcare delivery.