- The American Medical Association estimated that $31 billion is spent annually on prior authorizations by providers.
- The Kaiser Family Foundation estimated 868.4 million hours are spent annually obtaining prior authorizations.
- According to Milliman, manual prior authorizations cost $10.78 per transaction vs. $2.07 for an electronic transaction. That’s $8.71 in savings per electronic transaction.
We are currently working with FQHCs that had huge backlogs with specialty referrals due to the manual nature of obtaining prior auths and putting together referral packets. What we have done is to integrate their EHRs (NextGen, Intergy) with payer web portals and have digitized specialty referral fax forms to nearly automate the referrals process. We pull new physician referral orders directly from NextGen and auto-populate payer web portals for submission and retrieve authorization approvals. We have seen up to a 4X improvement in productivity around referrals with no increase in FTEs. Referral worklists that used to take a week to get through are done in days. We are also able to pull customized reporting on referrals productivity for managers. How are others handling this issue? I know that a lot of people are using i2i, but the integration with NextGen doesn’t seem that straightforward. If you have any interest in learning more please message me or email at firstname.lastname@example.org