Healthcare Provider Partnerships Make Electronic Prior Authorization More Efficient
Key Highlights:
- Elevance Health uses digital data-sharing and electronic prior authorization tools to speed care decisions and reduce administrative burden for care providers.
- Two programs for care providers streamline or waive prior authorization requirements for more than 400 outpatient procedures for qualifying providers.
- These innovations improve provider efficiency, support faster patient care, and can save significant time and administrative costs across the healthcare system.
Elevance Health helps care providers adopt innovative data exchange platforms that make it possible for health plans and care providers to securely exchange real-time information about a patient’s conditions. Not only does this partnership help patients get timely care, but it also cuts down on the administrative cost and burden for both care providers and health plans. Elevance Health care provider partners have commended the efficiency and quickness of processing prior authorizations, and we continue to onboard more care providers in this program.
For certain value-based care medical groups, the Elevance Health Prior Authorization Pass (PA Pass) program (similar to commonly known “gold card” programs exempting providers from prior authorization requirements) waives over 400 outpatient procedure codes such as those for radiology, rehabilitation, general medicine, and minor surgeries. Care providers qualify for the program when they are in value-based payment arrangements with Elevance Health-affiliated plans and meet specific performance criteria. Currently, more than a dozen health systems in seven states representing thousands of physicians qualify for PA Pass. For example, Cleveland Clinic has been enrolled in Elevance Health’s PA Pass program since 2018.
For other medical groups, the Prior Authorization Optimization (PAO) program allows automatic and real-time approval for approximately the same list of over 400 outpatient procedure codes when the provider submits the authorization request electronically.
Care providers that adopt electronic prior authorization through our provider portals and select electronic medical records (EMRs) also benefit from two-way communication with clinicians at Elevance Health-affiliated plans, as well as cleaner and more complete authorization information leading to quicker clinical determinations. And care providers can access all authorization data in a single location and quickly check the status of any authorization, even if it was not initially submitted electronically.
Where prior authorization is needed, digital technologies have made it significantly faster and more efficient. One study found care providers can save an average of 14 minutes for each request when using electronic prior authorization; this translates to more time for care providers to spend with their patients. The study also estimated that by just conducting prior authorization via electronic clinical records, the healthcare industry could potentially save $515 million per year because of reduced administrative cost and burden. It’s important to highlight that these savings are administrative, as Elevance Health-affiliated plans do not use costs as a factor when making prior authorization determinations.