By Jeffrey Sullivan, chief technology officer of the cloud fax division, J2 Global, Inc.
Time may heal most wounds, but it has done little to lessen the sting of prior authorization.
Despite decades of streamlining and automating healthcare business transactions, prior authorization remains one of the most burdensome, complex and costly administrative activities in the industry that creates hardship for all stakeholders—providers, payors and patients, contributing an estimated $25 billion per year to healthcare costs in the U.S. This is primarily because it remains a largely manual process and, therefore, prone to error.
With the number of transactions steadily increasing year over year, providers and payors need to collaborate and push for an electronic solution. The effort will involve changes to technologies as well as processes and regulations.
The high cost of business as usual
Prior authorization (PA) is a check run by insurance companies and third-party payors before they agree to cover the cost of certain healthcare services and medications. It was designed to ensure patients received the most appropriate and cost-effective care. However, increased demand for documentation, along with lack of standardization and automation, are undermining its original intent.