8 Questions to Ask Before Choosing a Prior Authorization Solution Vendor

8 Questions to Ask Before Choosing a Prior Authorization Solution Vendor

8 Questions to Ask Before Choosing a Prior Authorization Solution Vendor

Hospitals and health systems face several challenges when it comes to optimizing revenue cycle management efficiency without compromising quality patient care. A challenge at the top of most organizations’ lists is prior authorization management. Why? In most healthcare organizations, prior authorization management has been the last piece of their revenue cycle management to be automated. Ironically, prior authorization automation offers the greatest opportunity to balance operational efficiency with patient care and satisfaction. Selecting the right vendor to streamline and automate your prior authorizations is a decision that requires careful consideration. For decision-makers in these care settings, it’s crucial to ask the right questions to choose a partner that aligns with your organization’s goals and values.

Here are eight key questions to help guide you in making an informed decision.

  1. What differentiates the vendor partner from others in the space?

There are (literally) hundreds of prior authorization solution vendors that address prior authorizations in some capacity for hospitals and healthcare systems. Most vendors advertise faster, simpler prior authorization management but don’t automate at all. They simply offer an outsourced option to manage the same manual processes. It can be confusing to determine what sets them all apart. Ask your potential vendor what sets them apart and whether their solution is an outsourced service or technology. Automation technology is almost always less expensive than outsourcing manual prior authorization management, and is far simpler. For Valer, it’s our single technology platform that automates submission, status checking, verification, reporting, and EHR synchronization across all healthcare settings, specialties, and payers from one portal.

  1. Does the prior authorization solution vendor have experience with similar healthcare settings?

First, ask about the prospective partner’s track record working with similar hospital systems. How familiar are they with the unique challenges and compliance requirements associated with your type of healthcare operation? Inquire about the vendor’s client portfolio and how their solutions have positively impacted similar organizations. Additionally, insights from existing clients can provide valuable perspectives on the prior authorization solution’s performance, reliability, and overall experience. Understanding the satisfaction levels of current users adds a layer of assurance before adopting the solution for your own team.

  1. How user-friendly is the prior authorization solution?

Usability is a crucial factor in the successful implementation of any software solution. A user-friendly prior authorization system can streamline workflows, reduce training time, and enhance efficiency. Ensure that the chosen vendor’s solution is intuitive, with a user interface that is easy to navigate for both your administrative staff and physician staff.

  1. Does the solution integrate seamlessly with existing systems?

In today’s interconnected healthcare environment – particularly in large hospital systems – integration capabilities should be top of mind before investing in a prior auth solution. Ask about the potential vendor’s ability to integrate seamlessly with your hospital’s existing electronic health record (EHR) system and other relevant software. Easier integrations mean minimal disruptions and enhanced data accuracy. On top of a seamless integration, look for a solution that can be tailored to your existing workflow.

  1. What support and training options are provided?

Effective support and comprehensive training beyond onboarding are essential components for the successful adoption of any new prior authorization solution. Inquire about the vendor’s support capabilities, including customer service availability, response times, and ongoing training options. A vendor that invests in customer success ensures a smooth transition and continued satisfaction.

  1. How does the vendor (and solution) address compliance and security concerns?

Compliance with healthcare regulations and safeguarding patient information is a non-negotiable priority. Assess the vendor’s commitment to compliance with industry standards, such as HIPAA. Additionally, inquire about the security measures in place to protect sensitive patient data and ensure data integrity throughout the prior authorization process, like HITRUST.

  1. What reporting and analytics capabilities are offered?

Data-driven insights are invaluable in improving processes and decision-making. Ask about the reporting and analytics features of the prior authorization solution. Does the solution provide real-time reporting tools? Do you have access to actionable insights based on payer authorizations, rates of approvals, and more? A vendor with robust reporting tools can help your hospital identify trends, optimize workflows, and make informed strategic decisions to enhance overall performance.

  1. What are the ROI expectations?

What return on investment can you expect, and how will you generate it? Inquire about the prior authorization solution partner’s pricing model, ongoing maintenance costs, and any potential hidden fees. Additionally, discuss the expected efficiency gains, reduced denials, and overall improvements in the prior authorization process.

Valer. Built Around You.

Choosing a prior authorization solution vendor is a significant decision that requires careful consideration and evaluation. By asking these eight key questions, hospital decision-makers can ensure they select a vendor that not only meets their current needs but also aligns with their long-term goals for enhancing operational efficiency and providing high-quality patient care. If your team is ready to speed and simplify your prior authorization and referral management, get in touch with the Valer team today.


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