Real-time prior authorization speeds up administrative tasks

NATIONAL REPORTS-Technology is helping insurers manage prior authorization requests. Prescription Solutions, a pharmacy benefits manager (PBM), and UnitedHealth Group recently launched an online service that allows physicians and healthcare professionals to submit requests in real time.

"The application's functionality is a result of collaboration between customer service and IT," says Mark Knutson, vice president, Prescription Solutions.

The service offers an auto-populate feature that can provide 95% of a patient's information and medication history from previously submitted claims.

Providers can also check the status of any prior authorization request online, Knutson says.

TIME IS MONEY

According to a national 2,400-physician survey by the American Medical Assn., 63% of physicians reported that they typically wait several days to receive preauthorization for test and procedures, while 13% report waiting more than a week. In addition, 69% of physicians reported waiting several days to receive preauthorization for drugs, while 10% wait more than a week.

Knutson says that physicians were involved in designing the automated prior authorization.

"We asked them to reach out to their colleagues in practice who have used the system to make sure it meets their needs," he says.

The portal is not currently linked to an e-prescribing system, but Knutson says that it will be added in the future. However, in many circumstances, the prescription has already been issued when the need for a prior authorization is realized, he adds.

The program improves providers' experiences through simplification and improves efficiency through access and availability to the portal. But in addition, the automated system can help increase growth capacity, allowing payers to use fewer resources and reduce operational expenses.