The 2020 AMA Prior Authorization Physician Survey surveyed 1000 primary care physicians and specialists nationwide and found that providers completed on average 40 prior authorizations per week. This was an increase from an average of 31 prior authorizations per week from the same study in 2018. This increase is so significant that 40% of physicians have staff who work exclusively on prior authorizations.
Delays in managing prior authorizations can result in delayed patient care or even aborted treatments. Myndshft Technologies is an industry leader in finding solutions to this dilemma.
Why are Prior Authorizations a Challenge?
Prior authorization influences whether a health insurance payer will approve or reject a prescribed course of treatment. Documentation for prior authorizations is very complex, and insurance companies have many requirements. There are no standards for protocol from one insurance company to the next.
It can take anywhere from one day to a month to process and approve a prior authorization request. The 2018 AMA Prior Authorization Survey reported that 26% of providers need to wait three days or more for a prior authorization decision from health plans.
What is at Stake?
Errors in documentation or delays in completing the request and approval process can adversely affect patient care. This is especially true in higher-risk scenarios where more complexities are present, such as with transitions of care from a hospital to a post-acute care facility. These parties need to coordinate information with one another and provide it to the insurance company in order to discharge and intake (a.k.a. transition) patients safely.
The hospital is penalized if a patient needs to stay admitted for each of any “avoidable days”. The post-acute care facility is penalized if they do not seek approval for the entirety of actually needed services prior to ever seeing the patient. For the patient, costs and health complications can go up as a result of the services being delayed. Other financial incentives are at risk to the insurance company and providers when the quality of service and outcomes are below certain thresholds. This logjam effect hurts everyone.
Another example, which on the surface seems more benign, is in the case of early interventions prescribed by a physician. Delays and frustrations from the prior authorization process often lead to one aborting treatment due to impatience. This can and often does lead to treatment in an emergency room instead, costing more money and suffering than if the patient had waited out the pre-authorization process.
Beyond the impact on patients, prior authorization is incredibly time-consuming for providers. According to a report in the Annals of Family Medicine, doctors spend on average six hours daily attending solely to administration. This is non-value-added time that doctors could be spending with their patients instead.
Consumers are Puzzled
Why would all of the insurance companies and healthcare providers need to keep copies of the same information in separate places? If these companies already have an agreement in place to determine payments and protocols for cases, then why is it so difficult to reach an agreement on each case? Why do we need duplicative administrative staff and case managers at each business entity instead of relying on one trusted source of truth? Where can I go to avoid this problem?
Myndshft Answers the Call for Change
Myndshft’s primary focus is on fixing the “administrative plumbing” that plagues some healthcare organizations. For many, the administrative side of healthcare can be unnecessarily slow, complex, and expensive.
To solve this issue, Myndshft created a platform that connects all healthcare stakeholders automates and simplifies administrative transactions amplifies the collective intelligence of the entire network. This allows care to be expedited and improves outcomes while lowering costs for all parties.
One of the most important and easiest areas to focus automation on is revenue cycle management. Revenue cycle management has many highly manual processes with a lot of reconciliation.
Myndshft offers a variety of electronically streamlined solutions for
- eligibility and benefits verification
- coordination of benefits
- insurance discovery
- patient financial responsibility
- prior authorization
By automating these repetitive processes with A.I. business rules and blockchain technology, providers and insurance companies can be assured of greater accuracy and fewer delays in care delivery. Gone are the days of taking doctors’ orders and dealing with the bill later. Patients and doctors can now more openly discuss costs and treatment options while still in the exam room together.
How Does Myndshft Help with Prior Authorization?
Myndshft offers an automated solution that is designed for the specific needs of
- post-acute care facilities
- diagnostics and genomic labs
- specialty pharmacies
- infusion providers
- primary care
- other alternative site care organizations
- Insurance companies
Through this solution, care providers can automate the entire prior authorization workflow beginning as early as when a patient is first referred or scheduled. Myndshft eliminates the need to manually cut and paste data from portals by connecting directly with the Provider’s electronic health record, pharmacy, laboratory, and insurance company systems. Myndshft is accelerating advancements to improve trust while eliminating unnecessary intermediaries. The use of Myndshft can reduce manual tasks by as much as 90%, which allows organizations to resolve more prior authorization requests with less time and less effort.
What Makes Myndshft’s Platform Unique?
Myndshft’s solutions are built upon something they call their “CognitiveBus”, Myndshft’s proprietary artificial intelligence engine. CognitiveBus is also an accelerator, a toolkit, and a native enterprise blockchain platform. This platform is designed to meet the unique needs of healthcare organizations and is the first of its kind.
CognitiveBus has “plug and play” tooling, industry accelerators, and cognitive building blocks. These capabilities allow the platform to remove the normal complexity that is associated with deploying artificial intelligence, making it more affordable and accessible to the average provider office or facility.
Myndshft works by maintaining a vast library of rules for thousands of payers. This allows the platform to automatically recognize the identities of patients and providers and verify that all data submitted for prior authorization is complete and complies with all rules and policies.
CognitiveBus allows Myndshft to do all of this instantaneously and function as a self-learning system. It then advises the insurance company whether or not to approve, deny or manually review. When the insurance company makes a decision that choice goes to a feedback loop allowing Myndshft to improve accuracy on the next transaction.
Myndshft integrates with an organization’s existing infrastructure, so users are not required to learn new software or log into an extra portal.
Furthermore, Myndshft continuously monitors the status of each prior authorization request that has been submitted. This eliminates the need for manual tasks such as making calls or sending emails.
Myndshft takes an end-to-end approach to fully automate the prior authorization process. This approach includes:
- utilizing an enterprise master patient index to identify each patient
- direct integration into core Health IT systems
- maintaining a comprehensive payer rules library to automatically synchronize eligibility and prior authorization rules
- real-time verification of eligibility and benefits
- a single source for direct connections to all payers
Through this approach, Myndshft offers a fully automated and orchestrated solution that operates in real-time.
With significant strides in the US market and through strategic channel partnerships emerging we believe you or a loved one will soon benefit from this quality-of-life improving solution even if you do not actually see it with your own eyes. We also believe Myndshft is well-positioned to become a major stakeholder in the advent of smart contracts and decentralized insurance communities.
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