Harnessing Prior Authorization Automation for Epic Workflows
Prior authorizations are the very definition of complexity – tedious forms, portal juggling, error-prone processes, and more. For Oregon Health & Science University, managing unique payer requirements across multiple plans meant endless hours of logging into dozens of unique web portals for submissions and status checking, and filling out fax forms. Enter automation.
In our latest webinar, OHSU’s Joe Whipple provides a look under the hood at the organization’s automated prior authorization workflows and how Valer seamlessly fits into their operations, helping to speed and simplify prior auth management and sync with Epic.
Automated Submission: Payer Portals & Fax
We all know the most headache-inducing, mundane part of the prior authorization process is interacting with a myriad of payer portals and fax forms. OHSU’s Medicaid plans alone have approximately 15 fee-for-service and managed care organization plans with different portals and fax forms for their staff to toggle between when working on a prior auth submission. The more manual the data entry process is, the higher the risk of human error.
How Valer Delivers:
By utilizing Valer, OHSU’s team interacts with only a single portal to submit all prior authorization requests to every insurance payer with the same workflow. The Valer platform pulls all diagnostic and CPT codes, along with patient, provider, payer, and facility data and clinical information from Epic and automatically populates it into the correct payer portal or fax form. This automation reduces human error while boosting staff productivity.
Automated Status & Verification: One Dashboard for All Prior Auths
Manual prior authorization processes require team members to navigate to each individual payer portal, check in on their submission, and determine its status. Administrative teams all have their own protocols for this process, but at OHSU, the team was checking them once a day in the mornings. This leaves room for delays in care when submission information is not checked or updated in real-time.
How Valer Delivers:
Valer offers a centralized portal for all in-progress authorizations, providing a comprehensive view of each prior authorization request’s status – submitted, outstanding, denied, etc. Pending statuses are automatically checked. In OHSU’s case, Valer automatically updates prior authorization statuses four times a day. Updates are made in near-time and without human intervention, allowing for greater visibility across all submissions. This visibility helps to improve authorized days out and reduce delays in care.
Comprehensive Reporting: Staff & Payers
Data drives decisions. Administrative teams can’t identify bottlenecks and mitigate delays without insight into the exact prior authorization hold-ups, whether on the staff or payer side. For OHSU, establishing a process for monitoring internal staff productivity as well as payer performance was integral when considering automation.
How Valer Delivers:
Depending on the analytics that teams are looking to track, Valer can provide insights into how staff are performing and where there are opportunities for improvement on the payer side. How many touches have staff completed? How long do authorizations typically take? Where are we seeing an uptick in denials? All of these factors can inform future operations so that teams can maximize staff time and limit denials.
Bi-Directional EHR Sync: Closing the Loop to System of Record
The final step for any prior authorization submission is uploading the result and proof of approval back into the EHR system or other system of record. Originally a manual process for OHSU, inputting incorrect information was always possible. It was critical for the organization to select a prior authorization automation solution that easily integrated with Epic to ensure the same documents that contain the approval or denial information are correctly filed and saved.
How Valer Delivers:
Valer automates the process of pushing submission information back into Epic without human intervention. The team has drastically reduced denials by removing the need for manual input. The reporting capabilities of Valer also provide proof of error on the payer side that can be used within the appeals process.
Benefits of Automation for OHSU
Since partnering with Valer, OHSU transformed its prior auth processes by targeting the manual, error-prone portions of its workflows to create an automated workflow that meets their needs. The team is benefitting from improved staff productivity, patient satisfaction, and increased revenue. The key priority for OHSU was choosing a vendor that allowed for continuous improvement of processes and workflows. Valer ensures that the platform is solving the pain points of its health system partners and clients by working with the internal team to customize automation capabilities on an ongoing basis.
To learn more about OHSU’s prior authorization management processes and how your organization can gain similar workflow improvements, watch our webinar today: How OHSU Is Automating Prior Authorization Management for Speed & Simplicity
