Physicians complete an average of 41 prior authorizations each week and spend an average of 2 days on the processes, according to the American Medical Association.
Below is a workflow for prior authorization on medication in a HIV Clinic. By the way, fax is still the preferred way of communication today in the medical world.
There are 8 steps to get prior authorization approved from initial denial if physicians are doing everything right on the first try. Out of the 8 steps, 4 actions are either acquiring information or delivering information to insurance companies. These steps can be done by AI. More importantly, AI can be triggered on a patient's first day of visit, providing guidance on medication and medical necessity requirements, to avoid the denial.
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