Electronic Health Reporter

AGS Health, a leading provider of tech-enabled revenue cycle management (RCM) solutions and strategic growth partner to healthcare providers across the U.S., announced today the release of Intelligent Authorization, a single-source solution that automates and optimizes the financial clearance process and avoids prior authorization-related denials.

Part of AGS Health’s AI Platform, Intelligent Authorization streamlines and expedites processes by up to 90% through a variety of configurable automation solutions that improve operational efficiency, reduce costs, and enhance the patient experience.

“Half of all denials can be traced back to prior authorization and other front-end revenue cycle issues, jeopardizing provider organizations’ financial health and negatively impacting the patient experience by limiting transparency and delaying access to care,” said Matt Bridge, senior vice president of RCM Services, AGS Health. “Intelligent Authorization addresses the underlying issues causing prior authorization-related denials while streamlining and accelerating financial clearance processes. Customers report doubling production volumes and tripling the number of days in advance their patient access teams can secure authorizations, which in turn expedites appointments to better support patient needs and fill open time slots – resulting in improved revenue growth and an enhanced patient financial experience.”

A platform-agnostic solution, Intelligent Authorization prevents denials, reduces aged A/R, improves net revenue reimbursements, and increases clean claim rates across a variety of specialties, including radiology, oncology, occupational and physical therapy, surgery, and infusion/diagnostics. Compared to manual processes, it enhances productivity and reduces the time required for financial clearance activities, delivering:

• 75%-85% faster eligibility and benefit determinations
• 85%-90% improvement in authorization determination time
• 65%-80% less time spent on authorization initiations
• 75%-85% shorter authorization follow-up times
• Up to 80% faster price estimations

Intelligent Authorization achieves these outcomes by automating eligibility and benefits determination processes, including order entries, scheduling, rescheduling, and monthly and annual re-verification processes. It automates authorization status via robotic process automation (RPA) and generates good faith estimates based on the fee schedule and embedded payer- and client-specific rules, which are then transferred back to the EMR.

Finally, Intelligent Authorization offers insightful and actionable analytics including self-service reports, customized dashboards, and flexible data management that enables users to view insights across different dimensions, create action plans, and make decisions faster.

“Smart workflow tools feature fast, flexible data transfers to the EMR through HL7, simplified task management and automated case assignment, and enhanced document management and accessibility, all of which come together in Intelligent Authorization to eliminate financial clearance issues created by error-prone, time-consuming manual processes,” said Suhas Nair, director of product management, AGS Health. “By leveraging the latest advances in RPA and AI technologies, Intelligent Automation helps healthcare organizations implement the tools needed to strengthen their financial footing and better service their patients.”