PRIOR AUTHORIZATION REVIEW
Healthcare payers receive referral requests from members and providers for authorization of medical services outside the scope of what’s provided by their primary care provider. Payers then have to assess the appropriateness of the requested service using business rules and decision logic.
Using multiple, disconnected systems to work through this prior authorization process is extremely time-consuming, causing delays in patient response times when their health is on the line.
Additionally, using manual human review and decision-making results in costly errors from approving unnecessary and expensive services.