Prior authorization is the largest administrative burden on providers, which often results in tense relationships with contracted payers. An individual ordering physician spends an average of 16 hours per week, or $80,000 each year. Payers aren’t immune to this administrative burden either. In 2019, the average cost for a prior authorization was $3.321. More importantly, according to the American Medical Association’s annual physician survey, 91% of physicians said prior authorization can lead to negative clinical outcomes for the patient2.
Edifecs is fully automating prior authorization at the point of care by utilizing the provider’s EHR system. Rather than go to a separate portal, providers can now request prior authorizations right in the electronic health record. We’re enabling electronic forms and automating this process by leveraging AI technology and existing EHR integration from our Risk Adjustment business through our Talix and Health Fidelity acquisitions. Our solution also utilizes FHIR® Standards to ensure ongoing compliance while improving collaboration between the payer and provider, enhancing patient outcomes, and improving satisfaction.
- 2019 CAQH Core Index
- 2021 Prior Authorization Annual Physician Survey