![]() ![]() ![]() Transformation benefitsĪlthough advanced technology such as automation can improve PA workflows, only 21% of prior authorizations are fully electronic, according to the Council for Affordable Quality Healthcare’s 2021 CAQH Index.¹Īutomating administrative processes could mitigate some of the current challenges by enabling data interoperability and improving experiences for both members and providers. Electronic prior authorization processes can expedite the time from submission to decision-making, improving the ability to meet Centers for Medicare & Medicaid Services time frames (seven days for standard requests, 72 hours for expedited). But in their current form, these nonstandardized, manual processes present challenges for the smooth processing of PAs, including physician burnout, huge costs to health care, delays or absence of appropriate care for patients, and a suboptimal stakeholder experience.Īll stakeholders have to spend an enormous amount of time managing information for decision-making, necessitating the alignment of many resources to make it work. PAs can prevent wholly inappropriate service utilization or, more commonly, ensure that first-line treatments are attempted before care is escalated to more invasive or risky therapies.
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