Prior Authorization Software Development Solution

Patients who walk into a clinic or hospital for medical services need pre-approval from their insurance payer. Only after this approval or authorization would providers move forward with the medical services. The entire prior authorization process aims to ascertain that the health plans will cover the medical services. Providers may lose reimbursements from payers if they provide services not authorized by the payers or covered by the health plan. So, prior authorizations are vital for overall revenue cycle management.

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Software For Preauthorization in RCM

This is one of the first steps in the process of medical care. Whenever a patient walks into a healthcare organization, their health plan is verified to ascertain that the medical services are covered. OSP can include this feature within its prior authorization software to help accelerate verifying patients’ eligibility. Our custom healthcare software solutions will speed up this process and ensure that providers wouldn’t have to render services not covered by health plans.

In addition to the providers, this will also benefit the patients, as they would know the extent of their coverage. To sum it up, OSP’s function for eligibility verification will make up an important part of the revenue cycle management process.

This is one of the most common reasons providers are denied reimbursements. The services they render to patients might sometimes be deemed unnecessary, causing denials from payers. OSP can develop prior authorization software solutions that will minimize medical necessity denials. Our solution is updated with the newest rules for medical necessity for Medicare and other commercial payers. This will prevent denials from payers in cases where providers had to render necessary services.

OSP’s solutions for preauthorization in RCM will prevent the loss of reimbursements for providers and also help patients receive the care they need. In other words, this feature helps the providers, patients, and payers.

OSP can customize prior authorization software according to the needs of an organization and include automation in it. As organizations grow, automated prior authorization will increase the speed of the workflows, leading to better staff productivity and reduced patient wait time. Our solutions will enable the hospital staff to automate all the manual, repetitive activities involved in the prior authorization management process. Doing so saves overhead and also prevents errors, leading to better revenues.

Automation reduces the workload involved in any process. When it comes to the overall prior authorization management, automation goes on to benefit all the stakeholders involved.

Patient and provider information entered into the insurance verification and authorization software needs to be accurate. Any inconsistencies will result in denials and a tedious process of redoing things. It will also increase the wait times for patients needing an urgent procedure immediately. OSP can develop healthcare prior authorization software with a feature for scrubbing errors. From highlighting errors in documentation to notifying about missing data, our authorization software will prevent denials by minimizing or eliminating the chances of errors.

Error scrubbing in prior authorization software for healthcare organizations will be important to the overall revenue cycle management systems.

Automated prior authorization software in healthcare must integrate seamlessly with a hospital’s EHR software. This enables the hassle-free exchange of patient data, as it will be stored centrally in a secure repository. OSP has been a leader in custom healthcare software product development and can develop the necessary APIs to integrate prior authorization software. This will accelerate seeking prior authorizations and speed up insurance verification. The software can access patients’ medical histories and connect and optimize the approval process.

Integrated healthcare solutions boost the efficiency and productivity of all hospital workflows. This is especially true in the case of large hospitals that must see dozens or even more than a hundred patients each day. Secure, seamless exchange of data increases the efficiency of operations significantly.

Benefits 

This is one of the main advantages of using automated healthcare solutions for authorization management. It accelerates the process by automating the manual parts of it and saving time and energy for the staff in the process. In doing so, our prior authorization software helps reduce the overhead and prevents denials. Reduction in overhead and the number of denials eventually results in an improvement in revenues.

Delays in obtaining authorization for an important procedure have resulted in the worsening of patients’ health. But OSP’s prior authorization software solutions accelerate the process of pre-approvals to enable patients to receive the care they need. Reducing delays will prevent a worsening in patients’ health and improve the overall patient experience.

The processes involved in prior authorization and the subsequent follow-ups take up a significant amount of time for the staff. This problem compounds in the case of large hospitals that perform many complex surgeries in a day and must seek numerous prior authorizations. But OSP’s solutions for prior solutions reduce the time and effort required by leveraging automation. This eventually leads to an improvement in the overall efficiency of operations.

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