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About digital prior authorization
Prior authorization is a management process by which healthcare providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.
The current prior authorization process is extremely burdensome and time-consuming–the average physician must complete 41 prior authorizations per week, which translates into about 14 labor hours for prior authorizations alone, according to a 2020 American Medical Association survey. It's also one of the most costly administrative transactions, with an average expenditure of about $11 for each request. But the prior authorization landscape is changing, and the lost time and sunk costs are decreasing as intelligent automation becomes commonplace.
While a manual prior authorization takes an average of 21 minutes, a digital transaction can be completed in about four minutes, with fewer denials and faster turnaround time.
We've seen a steady shift in the industry–the results are undeniable. Health systems are turning increasingly to digital prior authorization solutions that leverage robotic process automation (RPA) to generate, submit, and monitor the status of prior authorization requests. Organizations doing this well are seeing millions of dollars in additional revenue.
What many of the leading solutions offer:
- Requirements identification and knowledge base
- Automated form completion
- Forms library
- Automated documentation collection
- Automated submission
- Continuous status monitoring
Introduction to the report
The Top Prior Authorization Companies Report is a resource designed to guide healthcare professionals in their quest for exceptional operational and customer oriented solutions. This report offers perspective on prominent provider documentation companies as reflected in the client reviews gathered on AVIA Marketplace and presents a selection of leading-edge solutions and companies.
This report is organized around client reviews that provide insight into the impact these solutions have had with the organizations they work with and include concise summaries that could assist in pinpointing solutions tailored to your unique needs. Our AVIA Marketplace serves as an additional resource, facilitating access to detailed company profiles, verified client lists, comparison of various solutions, and Match Scores to streamline your selection process. For even greater depth, AVIA experts are available through a Marketplace Product Review (for digital health solutions) and AVIA Membership (for hospitals and health systems). Ready to learn more? Send us a note!
Our methodology
The data that powers this report stems directly from the AVIA Marketplace, informed by reviews and by the number of verified health system clients associated with each company featured in the marketplace. In observance of confidentiality agreements, the complete client lists may not always be available from vendors.
Please note that the data presented is dynamic and subject to change over time. Therefore, we advise that decisions drawn from this information should be made judiciously, backed by thorough consideration.
AVIA's perspective and report limitations
Please note that this information does not reflect the opinions or views of AVIA as a whole, or AVIA Advisory Services. Rather, it reflects data captured on AVIA Marketplace at a point in time. This data is subject to change over time.
We at AVIA acknowledge the diverse strategies hospitals employ when selecting technologies. The reviews herein can offer valuable insight, but we also encourage considering other factors, like EMR integration, experience with clients similar to your organization, or overall market presence, which may prove pivotal in decision-making. We endeavor to provide a comprehensive analysis on these other aspects as well.
Our unique Product Grid, powered by our proprietary Match Score, is a useful tool to consider in your evaluation process. This methodology ensures that the products featured not only meet the buyer’s specific requirements but also exhibit solid market establishment.
Top-rated prior authorization companies
The top-rated prior authorization companies were the most-reviewed within their product category. Companies in this section have all received the “top-reviewed” recognition and the order does not indicate a ranking.
5.0
HealthNautica’s eORders™, software is a comprehensive, easy-to-use, cloud solution for managing the entire perioperative process and surgical scheduling without changing your scheduling system. It begins with the physician’s office filling out an online surgery scheduling or procedure request.
All orders are legible, complete, screened for CMS Medical Necessity, incorporate SCIP, VTE, SSI and ACS NSQIP measures, verified for insurance eligibility, pre-certified and satisfy edits by CMS, commercial payers and the facility. Our solution ensures efficient surgery center scheduling and block time management while streamlining processes such as prior authorization.
5.0
CampTek Software is a Full-Life-Cycle Intelligent Automation SaaS Provider with proven results implementing and supporting automation solutions through our successful methodology. Our unique hosted model offers many powerful advantages including a shorter time to market, 24/7 support and overall lower cost of entry. Our approach is simple and repeatable. CampTek will be with you on every step of your RPA & AI Journey!
5.0
Valer’s technology speeds and simplifies prior authorization and referral management by automating submissions, status checking, verification, reporting, and EHR synchronization across all mid-to-large sized healthcare settings, specialties, and payers from one platform and portal. All built just for you.
Valer’s automation technology enables our clients to reduce labor cost, claim denials from avoidable prior authorization errors, and writeoffs stemming from denials. With prior authorization approvals further in advance of scheduled treatments and procedures, Valer enables fewer rescheduled and abandoned appointments. Patients are happier, providers are happier, and staff are happier.
5.0
Make your operations more efficient: With Passport Authorizations, inquiries take place without user intervention, as does status monitoring. Submissions guide staff through the workflow, auto-filling all information Experian Health has received and prompting users only if their involvement is required. Access the industry’s most complete payer database: Experian Health’s pre-authorization knowledge base stores and dynamically updates payer prior authorization requirements. Your staff can check whether prior authorization is required for a particular procedure or service, and the knowledge base automatically responds to queries with information needed.
5.0
Waystar delivers innovative technology that simplifies and unifies healthcare payments. The company’s cloud-based platform helps healthcare providers across all care settings streamline workflows, improve financial performance and bring more transparency to the patient financial experience. Waystar solutions have been named Best in KLAS or Category Leader by KLAS Research 16 times (across multiple product categories) and earned multiple #1 rankings from Black Book. The Waystar platform is used by more than half a million providers, 1,000 health systems and hospitals, and 5,000 payers and health plans—and integrates with all major hospital information and practice management systems. On an annual basis, Waystar’s AI-powered solutions process $5B in patient payments, generate $4B in out-of-pocket estimates and process claims representing approximately 40% of the U.S. patient population.
5.0
R1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. R1’s proven and scalable operating models seamlessly complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
5.0
Cohere Health is a clinical intelligence company that provides intelligent prior authorization as a springboard to better quality outcomes by aligning physicians and health plans on evidence-based care paths for the patient’s entire care journey. Cohere’s intelligent prior authorization solutions reduce administrative expenses while improving patient outcomes. The company is a winner of the TripleTree iAward and has been named to both Fierce Healthcare’s Fierce 15 and CB Insights’ Digital Health 150 lists. Cohere’s investors include Flare Capital Partners, Define Ventures, Deerfield, Polaris Partners, and Longitude Capital.
Find your new prior authorization solution.
Prior authorizations are some of the most frustrating, time-consuming, and costly administrative tasks that providers must complete, with most physicians submitting dozens each week. But electronic prior authorization solutions and intelligent automation drastically reduce the time and effort required for each transaction with tools like automated eligibility checks, forms completion, and continuous status monitoring to increase first-pass approvals and streamline appeals and documentation.
Visit AVIA Marketplace to explore the companies listed in this report and thousands of other digital health companies and solutions. You’ll find verified client lists, use cases, differentiators, and more to help you streamline the vendor selection process and identify companies that can fulfill the unique needs of your health system.
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