prior authorization process automation

The Impact of Prior Authorization Process Automation in Healthcare

In healthcare, prior authorization requires providers to secure approval from insurance payers before delivering services, often leading to delays in patient care. One in three providers report that these delays significantly affect patient access. The traditional manual process involves checking insurance details, submitting requests, and following up, which can become time-consuming.

Automated systems offer a more efficient solution, quickly retrieving patient data, validating information, and preparing requests. This automation not only updates medical records but also tracks request statuses. The challenges of manual PA include rising costs, with 35% of providers hiring additional staff to manage requests. Each manual authorization costs about $11 and takes roughly 20 minutes to process. Physicians indicate that PA adds considerable strain to their workloads, with 93% acknowledging its impact.

Orbit’s AI-driven prior authorization process automation tackles these challenges by providing significant cost savings—around 60% per authorization and an estimated $449 million across the U.S. healthcare system. It streamlines workflows, saving provider groups up to 24 hours daily, cutting processing time to just five minutes per request, and minimizing human error. The automated system also reduces turnaround times by 55%, allowing staff to save nearly 12 hours each week. By enhancing efficiency and accuracy, Orbit’s solution improves patient experiences and alleviates administrative burdens on healthcare providers.

Prior Authorization Automation
Source: Orbit Healthcare